1
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Lowenthal ED, Chapman J, Ohrenschall R, Calabrese K, Baltrusaitis K, Heckman B, Yin DE, Agwu AL, Harrington C, Van Solingen-Ristea RM, McCoig CC, Adeyeye A, Kneebone J, Chounta V, Smith-Anderson C, Camacho-Gonzalez A, D'Angelo J, Bearden A, Crauwels H, Huang J, Buisson S, Milligan R, Ward S, Bolton-Moore C, Gaur AH. Acceptability and tolerability of long-acting injectable cabotegravir or rilpivirine in the first cohort of virologically suppressed adolescents living with HIV (IMPAACT 2017/MOCHA): a secondary analysis of a phase 1/2, multicentre, open-label, non-comparative dose-finding study. Lancet HIV 2024; 11:e222-e232. [PMID: 38538161 PMCID: PMC11061207 DOI: 10.1016/s2352-3018(23)00301-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/06/2023] [Accepted: 11/13/2023] [Indexed: 04/16/2024]
Abstract
BACKGROUND Long-acting injectable cabotegravir and rilpivirine have demonstrated safety, acceptability, and efficacy in adults living with HIV-1. The IMPAACT 2017 study (MOCHA study) was the first to use these injectable formulations in adolescents (aged 12-17 years) living with HIV-1. Herein, we report acceptability and tolerability outcomes in cohort 1 of the study. METHODS In this a secondary analysis of a phase 1/2, multicentre, open-label, non-comparative dose-finding study, with continuation of pre-study oral combination antiretroviral treatment (ART), 55 adolescents living with HIV-1 were enrolled to receive sequential doses of either long-acting cabotegravir or rilpivirine and 52 received at least two injections. Participants had a body weight greater than 35 kg and BMI less than 31·5 kg/m2 and had been on stable ART for at least 90 consecutive days with an HIV-1 viral load of less than 50 copies per mL at a participating IMPAACT study site. Participants had to be willing to continue their pre-study ART during cohort 1. The primary objectives of the study were to confirm doses for oral and injectable cabotegravir and for injectable rilpivirine in adolescents living with HIV. This analysis of participant-reported outcomes included a face scale assessment of pain at each injection and a Pediatric Quality of Life Inventory (PedsQL) at baseline and week 16 for participants in the USA, South Africa, Botswana, and Thailand. A subset of 11 adolescents and 11 parents or caregivers in the USA underwent in-depth interviews after receipt of one or two injections. This trial is registered at ClinicalTrials.gov, NCT03497676. FINDINGS Between March 19, 2019, and Nov 25, 2021, 55 participants were enrolled into cohort 1. Using the six-point face scale, 43 (83%) of participants at week 4 and 38 (73%) at week 8 reported that the injection caused "no hurt" or "hurts little bit", while only a single (2%) participant for each week rated the pain as one of the two highest pain levels. Quality of life was not diminished by the addition of one injectable antiretroviral. In-depth interviews revealed that parents and caregivers in the USA frequently had more hesitancy than adolescents about use of long-acting formulations, but parental acceptance was higher after their children received injections. INTERPRETATION High acceptability and tolerability of long-acting cabotegravir or rilpivirine injections suggests that these are likely to be favoured treatment options for some adolescents living with HIV. FUNDING National Institutes of Health and ViiV Healthcare.
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Affiliation(s)
- Elizabeth D Lowenthal
- The Children's Hospital of Philadelphia, Division of General Pediatrics and Global Health Center, Philadelphia, PA, USA; University of Pennsylvania Perelman School of Medicine, Departments of Pediatrics and Biostatistics, Epidemiology and Informatics, Philadelphia, PA, USA.
| | - Jennifer Chapman
- The Children's Hospital of Philadelphia, Division of General Pediatrics and Global Health Center, Philadelphia, PA, USA
| | | | | | - Kristin Baltrusaitis
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Dwight E Yin
- National Institute of Allergy and Infectious Diseases (NIAID) Division of AIDS, National Institutes of Health (NIH), Rockville, MD, USA
| | - Allison L Agwu
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | - Adeola Adeyeye
- National Institute of Allergy and Infectious Diseases (NIAID) Division of AIDS, National Institutes of Health (NIH), Rockville, MD, USA
| | | | | | | | | | - Jessica D'Angelo
- Northwestern University and Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Allison Bearden
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | | | - Jenny Huang
- ViiV Healthcare, Research Triangle Park, NC, USA
| | | | | | - Shawn Ward
- Frontier Science Foundation, Amherst, NY, USA
| | - Carolyn Bolton-Moore
- Centre for Infectious Disease Research in Zambia/University of Alabama Birmingham, Lusaka, Zambia
| | - Aditya H Gaur
- St Jude Children's Research Hospital, Memphis, TN, USA
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Gaur AH, Capparelli EV, Calabrese K, Baltrusaitis K, Marzinke MA, McCoig C, Van Solingen-Ristea RM, Mathiba SR, Adeyeye A, Moye JH, Heckman B, Lowenthal ED, Ward S, Milligan R, Samson P, Best BM, Harrington CM, Ford SL, Huang J, Crauwels H, Vandermeulen K, Agwu AL, Smith-Anderson C, Camacho-Gonzalez A, Ounchanum P, Kneebone JL, Townley E, Bolton Moore C. Safety and pharmacokinetics of oral and long-acting injectable cabotegravir or long-acting injectable rilpivirine in virologically suppressed adolescents with HIV (IMPAACT 2017/MOCHA): a phase 1/2, multicentre, open-label, non-comparative, dose-finding study. Lancet HIV 2024; 11:e211-e221. [PMID: 38538160 DOI: 10.1016/s2352-3018(23)00300-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 10/06/2023] [Accepted: 11/13/2023] [Indexed: 04/07/2024]
Abstract
BACKGROUND Combined intramuscular long-acting cabotegravir and long-acting rilpivirine constitute the first long-acting combination antiretroviral therapy (ART) regimen approved for adults with HIV. The goal of the IMPAACT 2017 study (MOCHA [More Options for Children and Adolescents]) was to assess the safety and pharmacokinetics of these drugs in adolescents. METHODS In this phase 1/2, multicentre, open-label, non-comparative, dose-finding study, virologically suppressed adolescents (aged 12-17 years; weight ≥35 kg; BMI ≤31·5 kg/m2) with HIV-1 on daily oral ART were enrolled at 15 centres in four countries (Botswana, South Africa, Thailand, and the USA). After 4-6 weeks of oral cabotegravir (cohort 1C) or rilpivirine (cohort 1R), participants received intramuscular long-acting cabotegravir or long-acting rilpivirine every 4 weeks or 8 weeks per the adult dosing regimens, while continuing pre-study ART. The primary outcomes were assessments of safety measures, including all adverse events, until week 4 for oral cabotegravir and until week 16 for long-acting cabotegravir and long-acting rilpivirine, and pharmacokinetic measures, including the area under the plasma concentration versus time curve during the dosing interval (AUC0-tau) and drug concentrations, at week 2 for oral dosing of cabotegravir and at week 16 for intramuscular dosing of cabotegravir and rilpivirine. Enrolment into cohort 1C or cohort 1R was based on the participant's pre-study ART, meaning that masking was not done. For pharmacokinetic analyses, blood samples were drawn at weeks 2-4 after oral dosing and weeks 4-16 after intramuscular dosing. Safety outcome measures were summarised using frequencies, percentages, and exact 95% CIs; pharmacokinetic parameters were summarised using descriptive statistics. This trial is registered at ClinicalTrials.gov, NCT03497676, and is closed to enrolment. FINDINGS Between March 19, 2019, and Nov 25, 2021, 55 participants were enrolled: 30 in cohort 1C and 25 in cohort 1R. At week 16, 28 (97%, 95% CI 82-100) of the 29 dose-evaluable participants in cohort 1C and 21 (91%; 72-99) of the 23 dose-evaluable participants in cohort 1R had reported at least one adverse event, with the most common being injection-site pain (nine [31%] in cohort 1C; nine [39%] in cohort 1R; none were severe). One (4%, 95% CI 0-22) participant in cohort 1R had an adverse event of grade 3 or higher, leading to treatment discontinuation, which was defined as acute rilpivirine-related allergic reaction (self-limiting generalised urticaria) after the first oral dose. No deaths or life-threatening events occurred. In cohort 1C, the week 2 median cabotegravir AUC0-tau was 148·5 (range 37·2-433·1) μg·h/mL. The week 16 median concentrations for the every-4-weeks and every-8-weeks dosing was 3·11 μg/mL (range 1·22-6·19) and 1·15 μg/mL (<0·025-5·29) for cabotegravir and 52·9 ng/mL (31·9-148·0) and 39·1 ng/mL (27·2-81·3) for rilpivirine, respectively. These concentrations were similar to those in adults. INTERPRETATION Study data support using long-acting cabotegravir or long-acting rilpivirine, given every 4 weeks or 8 weeks, per the adult dosing regimens, in virologically suppressed adolescents aged 12 years and older and weighing at least 35 kg. FUNDING The National Institutes of Health and ViiV Healthcare.
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Affiliation(s)
- Aditya H Gaur
- St Jude Children's Research Hospital, Memphis, TN, USA.
| | | | | | - Kristin Baltrusaitis
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mark A Marzinke
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | - Adeola Adeyeye
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - John H Moye
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Bethesda, MD, USA
| | | | - Elizabeth D Lowenthal
- University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Shawn Ward
- Frontier Science Foundation, Boston, MA, USA
| | | | | | | | | | | | | | | | | | - Allison L Agwu
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | | | - Ellen Townley
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Carolyn Bolton Moore
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; University of Alabama, Birmingham, AL, USA
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Oka S, Holohan V, Shirasaka T, Choi JY, Kim YS, Chamay N, Patel P, Polli JW, Ford SL, Crauwels H, Garside L, D'Amico R, Latham C, van Solingen-Ristea R, Baugh B, van Wyk J. Asian participants' experience in phase 3/3b studies of long-acting cabotegravir and rilpivirine: Efficacy, safety, pharmacokinetic, and virological outcomes through week 96. HIV Med 2024; 25:381-390. [PMID: 38147871 DOI: 10.1111/hiv.13588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/08/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVES Cabotegravir + rilpivirine (CAB + RPV) dosed monthly or every 2 months is the first complete long-acting (LA) regimen recommended by treatment guidelines for the maintenance of HIV-1 virological suppression. This post hoc analysis summarizes outcomes for Asian participants through week 96. METHODS Data from Asian participants naive to CAB + RPV randomized to receive dosing every 4 weeks (Q4W) or every 8 weeks (Q8W) in the FLAIR (NCT02938520) and ATLAS-2M (NCT03299049) phase 3/3b studies were pooled. The proportion of participants with plasma HIV-1 RNA ≥50 and <50 copies/mL (per FDA Snapshot algorithm), incidence of confirmed virological failure (CVF; two consecutive HIV-1 RNA ≥200 copies/mL), pharmacokinetics, safety, and tolerability through week 96 were assessed. RESULTS Overall, 41 Asian participants received CAB + RPV (Q8W, n = 17; Q4W, n = 24). At week 96, 83% (n = 34/41) of participants maintained HIV-1 RNA <50 copies/mL, none had HIV-1 RNA ≥50 copies/mL, and 17% (n = 7/41) had no virological data. No Asian participant met the CVF criterion. Drug-related adverse events occurred in 44% (n = 18/41) of participants; none were Grade ≥3. All injection site reactions were Grade 1 or 2; median duration was 2 days and most resolved within 7 days (90%, n = 390/435). CAB and RPV trough concentrations remained well above their respective protein-adjusted 90% inhibitory concentrations (CAB, 0.166 μg/mL; RPV, 12 ng/mL) through week 96. CONCLUSIONS CAB + RPV LA demonstrated high efficacy, with no participants having CVF, and an acceptable safety profile in Asian participants through week 96. These data support CAB + RPV LA as a complete regimen for the maintenance of HIV-1 virological suppression in Asian individuals.
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Affiliation(s)
- Shinichi Oka
- National Center for Global Health and Medicine, Tokyo, Japan
| | | | - Takuma Shirasaka
- AIDS Medical Center, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Jun Yong Choi
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Yeon-Sook Kim
- School of Medicine, Chungnam National University, Daejeon, South Korea
| | | | - Parul Patel
- ViiV Healthcare, Durham, North Carolina, USA
| | | | | | | | | | | | | | | | - Bryan Baugh
- Janssen Pharmaceuticals, Research & Development, Titusville, New Jersey, USA
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4
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Han K, Gevorkyan H, Sadik Shaik J, Crauwels H, Leemereise C, Bontempo G, Win B, Chounta V, Seal C, DeMoor R, D'Amico R, Spreen WR, Ford SL. Pharmacokinetics and tolerability of cabotegravir and rilpivirine long-acting intramuscular injections to the vastus lateralis (lateral thigh) muscles of healthy adult participants. Antimicrob Agents Chemother 2024; 68:e0078123. [PMID: 38038460 PMCID: PMC10777827 DOI: 10.1128/aac.00781-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/04/2023] [Indexed: 12/02/2023] Open
Abstract
Cabotegravir + rilpivirine administered via intramuscular gluteal injections is the first complete long-acting (LA) regimen approved for maintaining HIV-1 virologic suppression. The vastus lateralis (lateral) thigh muscle could be a potential alternative site of administration in circumstances such as injection site fatigue, intolerability, or contraindication for gluteal administration. Cabotegravir and rilpivirine pharmacokinetics and participant tolerability were evaluated following single intramuscular injections to the lateral thigh. Healthy adult participants received 4 weeks of daily oral cabotegravir (30 mg) and rilpivirine (25 mg), followed by a 10- to 14-day washout and single 3 mL intramuscular injections of cabotegravir LA 600 mg and rilpivirine LA 900 mg to the lateral thigh. Safety, tolerability, and pharmacokinetics were evaluated through 52 weeks post injection. Pharmacokinetic parameters were estimated using non-compartmental analysis. Fifteen participants (female at birth, n = 6) enrolled. Median age was 33 years. Median weight was 93.6 kg. Median body mass index was 31.4 kg/m2. One participant withdrew due to pregnancy after oral dosing before receiving an injection. Plasma concentrations at Weeks 4 and 8 were 15.4- and 5.3-fold above the protein-adjusted 90% inhibitory concentration for cabotegravir and 4.7- and 2.4-fold for rilpivirine, respectively. The most common injection site reactions were pain [28/28 (100%)], induration [15/28 (54%)], and swelling [12/28 (42%)]; 94% were Grade 1 or 2. Cabotegravir and rilpivirine plasma pharmacokinetic profiles observed in this study support further evaluation of thigh administration in target populations of people living with HIV-1. Tolerability of cabotegravir + rilpivirine LA intramuscular lateral thigh injections was similar to gluteal administration.
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Affiliation(s)
- Kelong Han
- Department of Clinical Pharmacology, Modeling & Simulation, GSK, Collegeville, Pennsylvania, USA
| | - Hakop Gevorkyan
- California Clinical Trials Medical Group in affiliation with PAREXEL, Glendale, California, USA
| | - Jafar Sadik Shaik
- Department of Clinical Pharmacology & Pharmacometrics, Janssen Research & Development, Spring House, Pennsylvania, USA
| | - Herta Crauwels
- Department of Clinical Pharmacology, Janssen Research & Development, Beerse, Belgium
| | | | | | | | | | | | | | | | | | - Susan L. Ford
- Department of Clinical Pharmacology, Modeling & Simulation, GSK, Durham, North Carolina, USA
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5
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Elliot E, Polli JW, Patel P, Garside L, Grove R, Barnett V, Roberts J, Byrapuneni S, Crauwels H, Ford SL, Van Solingen-Ristea R, Birmingham E, D'Amico R, Baugh B, van Wyk J. Efficacy, safety, and pharmacokinetics by BMI category in Phase 3/3b cabotegravir + rilpivirine long-acting trials. J Infect Dis 2023:jiad580. [PMID: 38134313 DOI: 10.1093/infdis/jiad580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/06/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Cabotegravir + rilpivirine (CAB + RPV) is a guideline-recommended long-acting (LA) injectable regimen for the maintenance of HIV-1 virologic suppression. This post hoc analysis summarizes CAB + RPV LA results by baseline body mass index (BMI) category among Phase 3/3b trial participants. METHODS Data from CAB + RPV-naive participants receiving every 4 or 8 week dosing in FLAIR, ATLAS, and ATLAS-2 M were pooled through Week (W) 48. Data beyond W48 were summarized by study (FLAIR through W96 and ATLAS-2 M through W152). HIV 1 RNA <50 and ≥50 copies/mL, confirmed virologic failure (CVF; two consecutive HIV-1 RNA ≥200 copies/mL), safety and tolerability, and plasma CAB and RPV trough concentrations were evaluated by baseline BMI (<30 kg/m2 [lower]; ≥ 30 kg/m2 [higher]). RESULTS Among 1245 CAB + RPV LA participants, 213 (17%) had a baseline BMI ≥30 kg/m2. At W48, 92% vs. 93% of participants with lower vs. higher BMI had HIV-1 RNA <50 copies/mL, respectively. Including data beyond W48, 18 participants had CVF; those in the higher BMI group (n = 8) all had at least one other baseline factor associated with CVF (archived RPV resistance-associated mutations or HIV 1 subtype A6/A1). Safety and pharmacokinetic profiles were comparable between BMI categories. CONCLUSION CAB + RPV LA was efficacious and well tolerated, regardless of baseline BMI category.Main point summary: CAB + RPV LA is effective in the maintenance of HIV-1 virologic suppression in adults regardless of BMI category, with longer-length needles (≥2 inches) recommend for those with BMI ≥30 kg/m2 to accommodate individual body habitus and ensure appropriate administration.
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Affiliation(s)
| | | | | | | | | | | | | | - Sri Byrapuneni
- Parexel International, Research Triangle Park, NC, United States
| | | | | | | | | | | | - Bryan Baugh
- Janssen Research & Development, Raritan, NJ, United States
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6
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Orkin C, Schapiro JM, Perno CF, Kuritzkes DR, Patel P, DeMoor R, Dorey D, Wang Y, Han K, Van Eygen V, Crauwels H, Ford SL, Latham CL, St. Clair M, Polli JW, Vanveggel S, Vandermeulen K, D’Amico R, Garges HP, Zolopa A, Spreen WR, van Wyk J, Cutrell AG. Expanded Multivariable Models to Assist Patient Selection for Long-Acting Cabotegravir + Rilpivirine Treatment: Clinical Utility of a Combination of Patient, Drug Concentration, and Viral Factors Associated With Virologic Failure. Clin Infect Dis 2023; 77:1423-1431. [PMID: 37340869 PMCID: PMC10654860 DOI: 10.1093/cid/ciad370] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/19/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Previously reported post hoc multivariable analyses exploring predictors of confirmed virologic failure (CVF) with cabotegravir + rilpivirine long-acting (CAB + RPV LA) were expanded to include data beyond week 48, additional covariates, and additional participants. METHODS Pooled data from 1651 participants were used to explore dosing regimen (every 4 or every 8 weeks), demographic, viral, and pharmacokinetic covariates as potential predictors of CVF. Prior dosing regimen experience was accounted for using 2 populations. Two models were conducted in each population-baseline factor analyses exploring factors known at baseline and multivariable analyses exploring baseline factors plus postbaseline model-predicted CAB/RPV trough concentrations (4 and 44 weeks postinjection). Retained factors were evaluated to understand their contribution to CVF (alone or in combination). RESULTS Overall, 1.4% (n = 23/1651) of participants had CVF through 152 weeks. The presence of RPV resistance-associated mutations, human immunodeficiency virus-1 subtype A6/A1, and body mass index ≥30 kg/m2 were associated with an increased risk of CVF (P < .05 adjusted incidence rate ratio), with participants with ≥2 of these baseline factors having a higher risk of CVF. Lower model-predicted CAB/RPV troughs were additional factors retained for multivariable analyses. CONCLUSIONS The presence of ≥2 baseline factors (RPV resistance-associated mutations, A6/A1 subtype, and/or body mass index ≥30 kg/m2) was associated with increased CVF risk, consistent with prior analyses. Inclusion of initial model-predicted CAB/RPV trough concentrations (≤first quartile) did not improve the prediction of CVF beyond the presence of a combination of ≥2 baseline factors, reinforcing the clinical utility of the baseline factors in the appropriate use of CAB + RPV LA.
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Affiliation(s)
- Chloe Orkin
- SHARE Collaborative, Department of Immunobiology, Queen Mary University of London, London, United Kingdom
| | | | | | - Daniel R Kuritzkes
- Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Parul Patel
- ViiV Healthcare, Durham, North Carolina, USA
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7
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Mehta R, Lagishetty CV, Angelis K, Aylott A, Kahl L, Blair L, Matthews J, Wynne B, Crauwels H, Underwood M, Adkison KK. Pharmacokinetic and pharmacokinetic/pharmacodynamic characterization of the dolutegravir/rilpivirine two-drug regimen in SWORD-1/-2 phase 3 studies. Br J Clin Pharmacol 2023; 89:2190-2200. [PMID: 36740580 DOI: 10.1111/bcp.15683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 12/19/2022] [Accepted: 01/14/2023] [Indexed: 02/07/2023] Open
Abstract
AIM SWORD-1 and SWORD-2 phase 3 studies concluded that switching virologically suppressed participants with HIV-1 from their current three- or four-drug antiretroviral regimen (CAR) to the two-drug regimen of once-daily dolutegravir (DTG, 50 mg) and rilpivirine (RPV, 25 mg) was safe, well tolerated and noninferior for maintaining HIV-1 suppression at week 48 and highly efficacious to week 148. A secondary objective was to characterize drug exposure and exposure-efficacy/safety relationships. METHODS Adults with plasma HIV-1 RNA <50 copies/mL were randomized to switch to once-daily DTG + RPV on day 1 or to continue CAR for 52 weeks before switching. Trough plasma concentrations (C0) of DTG and RPV, the proportion of participants with HIV-1 RNA <50 copies/mL and adverse events to week 100 were summarized and subjected to exposure-response analyses in the overall population, in the subset of participants who switched from CAR containing enzyme-inducing drugs and by age category (≥50 and <50 years). The relationship between C0avg (individual average C0 across visits) and efficacy/safety was investigated. RESULTS Although week 2 DTG and RPV C0 were lower in participants switching from enzyme-inducing antiretroviral drugs, C0 and C0avg stayed above in vitro antiviral protein binding-adjusted IC90 and to week 100 with viral suppression >89%. DTG or RPV C0avg showed no relationship with virologic failures or safety. Participants ≥50 years had similar C0avg and safety response to younger participants. CONCLUSION No clinically relevant relationship between DTG or RPV exposures and virologic or safety response was observed, confirming the DTG + RPV switch for participants as a safe and effective treatment.
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Affiliation(s)
| | | | | | | | | | - Libby Blair
- ViiV Healthcare, Durham, North Carolina, USA
| | | | - Brian Wynne
- ViiV Healthcare, Durham, North Carolina, USA
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8
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Overton ET, Richmond G, Rizzardini G, Thalme A, Girard PM, Wong A, Porteiro N, Swindells S, Reynes J, Noe S, Harrington C, Español CM, Acuipil C, Aksar A, Wang Y, Ford SL, Crauwels H, van Eygen V, Van Solingen-Ristea R, Latham CL, Thiagarajah S, D'Amico R, Smith KY, Vandermeulen K, Spreen WR. Long-acting cabotegravir and rilpivirine dosed every 2 months in adults with HIV-1 infection: 152-week results from ATLAS-2M, a randomized, open-label, Phase 3b, noninferiority study. Clin Infect Dis 2023; 76:1646-1654. [PMID: 36660819 PMCID: PMC10156123 DOI: 10.1093/cid/ciad020] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/07/2022] [Accepted: 01/11/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Cabotegravir (CAB) + rilpivirine (RPV) dosed intramuscularly monthly or every 2 months is a complete long-acting (LA) regimen for the maintenance of HIV-1 virologic suppression. Here, we report the ATLAS-2M study Week 152 results. METHODS ATLAS-2M is a Phase 3b, randomized, multicenter study assessing the efficacy and safety of CAB+RPV LA every 8 weeks (Q8W) vs. every 4 weeks (Q4W). Virologically suppressed (HIV-1 RNA <50 copies/mL) individuals were randomized to receive CAB+RPV LA Q8W or Q4W. Endpoints included the proportion of participants with plasma HIV-1 RNA ≥50 copies/mL and <50 copies/mL, incidence of confirmed virologic failure (CVF; two consecutive measurements of ≥200 copies/mL), safety, and tolerability. RESULTS 1045 participants received CAB+RPV LA (Q8W, n=522; Q4W, n=523). CAB+RPV LA Q8W demonstrated noninferior efficacy vs. Q4W dosing, with 2.7% (n=14) and 1.0% (n=5) of participants having HIV-1 RNA ≥50 copies/mL, respectively. The adjusted treatment difference in proportions was 1.7% (95% CI 0.1 to 3.3), meeting the pre-specified noninferiority threshold of 4%. At Week 152, 87% of participants maintained HIV-1 RNA <50 copies/mL (Q8W, 87% [n=456]; Q4W, 86% [n=449]). Overall, 12 (2.3%) participants in the Q8W arm and two (0.4%) participants in the Q4W arm had CVF. Eight and 10 participants with CVF had treatment-emergent resistance-associated mutations to RPV and integrase inhibitors, respectively. Safety profiles were comparable, with no new safety signals observed since Week 48. CONCLUSIONS These data demonstrate the durability of virologic suppression with CAB+RPV LA Q8W or Q4W for ∼3 years, and confirm the long-term efficacy, safety, and tolerability of CAB+RPV LA as a complete regimen for the maintenance of HIV-1 virologic suppression.
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Affiliation(s)
- Edgar T Overton
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, United States; North American Medical Affairs, ViiV Healthcare, Durham, NC, United States
| | - Gary Richmond
- Department of Medicine, Broward Health Medical Center, Fort Lauderdale, FL, United States
| | - Giuliano Rizzardini
- Department of Infectious Diseases, Fatebenefratelli Sacco Hospital, Milan, Italy and School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Anders Thalme
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Pierre-Marie Girard
- Department of Infectious and Tropical Diseases and Inserm, University of Paris, St-Antoine Hospital, Paris, France
| | - Alexander Wong
- Department of Medicine, University of Saskatchewan, Regina, Canada
| | | | - Susan Swindells
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Jacques Reynes
- Department of Infectious Diseases, Montpellier University Hospital, Montpellier, France and Inserm, University of Montpellier, Montpellier, France
| | - Sebastian Noe
- HIV Research and Clinical Care Center, MVZ München Am Goetheplatz, Munich, Germany
| | - Conn Harrington
- Clinical Development, ViiV Healthcare, Durham, NC, United States
| | | | - Carolina Acuipil
- Research & Development, ViiV Healthcare, Durham, NC, United States
| | | | - Yuanyuan Wang
- Development Biostatistics, GSK, Collegeville, PA, United States
| | - Susan L Ford
- Clinical Pharmacology Modeling and Simulation, GSK, Durham, NC, United States
| | - Herta Crauwels
- Clinical Pharmacology, Janssen Research & Development, Beerse, Belgium
| | - Veerle van Eygen
- Clinical Microbiology and Immunology, Janssen Research & Development, Beerse, Belgium
| | | | - Christine L Latham
- Translational Medicine Research, ViiV Healthcare, Durham, NC, United States
| | | | - Ronald D'Amico
- Research & Development, ViiV Healthcare, Durham, NC, United States
| | - Kimberly Y Smith
- Research & Development, ViiV Healthcare, Durham, NC, United States
| | - Kati Vandermeulen
- Department of Infectious Diseases, Janssen Research & Development, Beerse, Belgium
| | - William R Spreen
- Research & Development, ViiV Healthcare, Durham, NC, United States
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9
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Patel P, Teichner P, Elliot E, Boffito M, Murray M, Polli JW, Baker M, Ford SL, Han K, Russu A, Crauwels H, D’Amico RD, Spreen WR, van Wyk J. Practical dosing guidance for the management of clinician-administered injections of long-acting cabotegravir and rilpivirine. Ther Adv Infect Dis 2023; 10:20499361231214626. [PMID: 38107552 PMCID: PMC10722954 DOI: 10.1177/20499361231214626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/30/2023] [Indexed: 12/19/2023] Open
Abstract
Cabotegravir (CAB) and rilpivirine (RPV) is the first complete long-acting (LA) injectable regimen recommended by treatment guidelines for the maintenance of HIV-1 virologic suppression in people with HIV-1 who are virologically suppressed on a stable antiretroviral regimen that is administered monthly (Q1M) or every 2 months (Q2M). As an alternative regimen to lifelong daily oral antiretroviral therapy, Q1M or Q2M dosing schedules are associated with increased patient satisfaction and treatment preference. In addition, it may address challenges associated with daily oral dosing, including fear of treatment disclosure or stigma, anxiety related to oral dosing adherence, and the daily reminder of HIV disease status. Cabotegravir + RPV LA is administered by clinical staff as two intramuscular injections dosed Q1M or Q2M. In this review, we share practical dosing guidance for CAB+RPV LA injectable therapy, including how to initiate therapy, schedule injection visits, manage dosing interruptions due to missed or delayed injection visits, manage errors in dosing, and transition to alternative antiretroviral therapy after discontinuation. Practical guidance on the clinical management of CAB+RPV LA dosing, including a detailed discussion using case-based scenarios that may be encountered in clinical practice, is provided. The clinician-administered CAB+RPV LA regimen has dosing management considerations that are flexible and considerate of the patient and has the potential to provide a highly desirable and efficacious alternative to daily oral antiretroviral therapy for many people with HIV-1.
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Affiliation(s)
- Parul Patel
- ViiV Healthcare, 410 Blackwell Street, Durham, NC 27701, USA
| | | | | | - Marta Boffito
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Imperial College London, London, UK
| | - Milena Murray
- Merck & Co, Inc, Rahway, NJ, USA
- Midwestern University and Northwestern Medicine, Chicago, IL, USA
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10
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Patel P, Ford SL, Baker M, Meyer C, Garside L, D'Amico R, Van Solingen‐Ristea R, Crauwels H, Polli JW, Seal C, Yagüe Muñoz I, Thiagarajah S, Birmingham E, Spreen WR, Baugh B, van Wyk J, Vannappagari V. Pregnancy outcomes and pharmacokinetics in pregnant women living with
HIV
exposed to long‐acting cabotegravir and rilpivirine in clinical trials. HIV Med 2022; 24:568-579. [PMID: 36411596 DOI: 10.1111/hiv.13439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/19/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Limited data exist on pregnant women living with HIV exposed to cabotegravir + rilpivirine (CAB + RPV). Outcomes in pregnant participants exposed to CAB + RPV, and pharmacokinetic washout data in those exposed to CAB + RPV long-acting (LA) with live births, are presented. METHODS Women exposed to one or more doses of CAB + RPV (oral/LA) from ViiV Healthcare-sponsored phase 2b/3/3b clinical trials and the compassionate use programme who became pregnant were included. Upon pregnancy in the trial programme, CAB + RPV was discontinued, an alternative antiretroviral regimen was initiated, and quarterly pharmacokinetic sampling for 52 weeks post-last injection was obtained. CAB + RPV continuation or alternative antiretroviral regimen initiation was decided by pregnant compassionate use programme participants and their treating physicians. RESULTS As of 31 March 2021, 25 pregnancies following CAB + RPV exposure at conception were reported (five oral, 20 LA), including four who conceived during pharmacokinetic washout following treatment discontinuation. There were eight elective abortions, six miscarriages (five in first trimester), one ectopic pregnancy, and 10 live births (one oral, nine LA), including one infant born with congenital ptosis. Among participants exposed to CAB + RPV LA at conception with live births, plasma CAB and RPV washout concentrations during pregnancy were within the range of those observed in non-pregnant women. CONCLUSION In this first analysis of pregnancy outcomes following CAB + RPV exposure at conception, 10 live births, including one with congenital anomaly, were reported. Plasma CAB and RPV washout concentrations during pregnancy were within the range of those in non-pregnant women. Pregnancy surveillance within ViiV Healthcare-sponsored clinical trials is ongoing, with dedicated pregnancy studies planned.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ciara Seal
- GlaxoSmithKline Collegeville Pennsylvania USA
| | | | | | | | | | - Bryan Baugh
- Janssen Research & Development Titusville New Jersey USA
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11
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Swindells S, Lutz T, Van Zyl L, Porteiro N, Stoll M, Mitha E, Shon A, Benn P, Huang JO, Harrington CM, Hove K, Ford SL, Talarico CL, Chounta V, Crauwels H, Van Solingen-Ristea R, Vanveggel S, Margolis DA, Smith KY, Vandermeulen K, Spreen WR. Week 96 extension results of a Phase 3 study evaluating long-acting cabotegravir with rilpivirine for HIV-1 treatment. AIDS 2022; 36:185-194. [PMID: 34261093 PMCID: PMC8711605 DOI: 10.1097/qad.0000000000003025] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/11/2021] [Accepted: 06/19/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND ATLAS (NCT02951052), a phase 3, multicenter, open-label study, demonstrated that switching to injectable cabotegravir (CAB) with rilpivirine (RPV) long-acting dosed every 4 weeks was noninferior at week (W) 48 to continuing three-drug daily oral current antiretroviral therapy (CAR). Results from the W 96 analysis are presented. METHODS AND DESIGN Participants completing W 52 of ATLAS were given the option to withdraw, transition to ATLAS-2M (NCT03299049), or enter an Extension Phase to continue long-acting therapy (Long-acting arm) or switch from CAR to long-acting therapy (Switch arm). Endpoints assessed at W 96 included proportion of participants with plasma HIV-1 RNA less than 50 copies/ml, incidence of confirmed virologic failure (CVF; two consecutive HIV-1 RNA ≥200 copies/ml), safety and tolerability, pharmacokinetics, and patient-reported outcomes. RESULTS Most participants completing the Maintenance Phase transitioned to ATLAS-2M (88%, n = 502/572). Overall, 52 participants were included in the W 96 analysis of ATLAS; of these, 100% (n = 23/23) and 97% (n = 28/29) in the Long-acting and Switch arms had plasma HIV-1 RNA less than 50 copies/ml at W 96, respectively. One participant had plasma HIV-1 RNA 50 copies/ml or higher in the Switch arm (173 copies/ml). No participants met the CVF criterion during the Extension Phase. No new safety signals were identified. All Switch arm participants surveyed preferred long-acting therapy to their previous daily oral regimen (100%, n = 27/27). CONCLUSION In this subgroup of ATLAS, 98% (n = 51/52) of participants at the Extension Phase W 96 analysis maintained virologic suppression with long-acting therapy. Safety, efficacy, and participant preference results support the therapeutic potential of long-acting CAB+RPV treatment for virologically suppressed people living with HIV-1.
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Affiliation(s)
| | | | | | | | | | - Essack Mitha
- Newtown Clinical Research Centre, Johannesburg, South Africa
| | - Alyssa Shon
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | | | | | | | | | - Susan L. Ford
- GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | | | | | | | | | | | - David A. Margolis
- ViiV Healthcare, Research Triangle Park, North Carolina, USA
- Brii Biosciences, Durham, North Carolina, USA
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12
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Overton ET, Richmond G, Rizzardini G, Jaeger H, Orrell C, Nagimova F, Bredeek F, García Deltoro M, Swindells S, Andrade-Villanueva JF, Wong A, Khuong-Josses MA, Van Solingen-Ristea R, van Eygen V, Crauwels H, Ford S, Talarico C, Benn P, Wang Y, Hudson KJ, Chounta V, Cutrell A, Patel P, Shaefer M, Margolis DA, Smith KY, Vanveggel S, Spreen W. Long-acting cabotegravir and rilpivirine dosed every 2 months in adults with HIV-1 infection (ATLAS-2M), 48-week results: a randomised, multicentre, open-label, phase 3b, non-inferiority study. Lancet 2021; 396:1994-2005. [PMID: 33308425 DOI: 10.1016/s0140-6736(20)32666-0] [Citation(s) in RCA: 141] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/28/2020] [Accepted: 10/07/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Phase 3 clinical studies showed non-inferiority of long-acting intramuscular cabotegravir and rilpivirine dosed every 4 weeks to oral antiretroviral therapy. Important phase 2 results of every 8 weeks dosing, and supportive modelling, underpin further evaluation of every 8 weeks dosing in this trial, which has the potential to offer greater convenience. Our objective was to compare the week 48 antiviral efficacy of cabotegravir plus rilpivirine long-acting dosed every 8 weeks with that of every 4 weeks dosing. METHODS ATLAS-2M is an ongoing, randomised, multicentre (13 countries; Australia, Argentina, Canada, France, Germany, Italy, Mexico, Russia, South Africa, South Korea, Spain, Sweden, and the USA), open-label, phase 3b, non-inferiority study of cabotegravir plus rilpivirine long-acting maintenance therapy administered intramuscularly every 8 weeks (cabotegravir 600 mg plus rilpivirine 900 mg) or every 4 weeks (cabotegravir 400 mg plus rilpivirine 600 mg) to treatment-experienced adults living with HIV-1. Eligible newly recruited individuals must have received an uninterrupted first or second oral standard-of-care regimen for at least 6 months without virological failure and be aged 18 years or older. Eligible participants from the ATLAS trial, from both the oral standard-of-care and long-acting groups, must have completed the 52-week comparative phase with an ATLAS-2M screening plasma HIV-1 RNA less than 50 copies per mL. Participants were randomly assigned 1:1 to receive cabotegravir plus rilpivirine long-acting every 8 weeks or every 4 weeks. The randomisation schedule was generated by means of the GlaxoSmithKline validated randomisation software RANDALL NG. The primary endpoint at week 48 was HIV-1 RNA ≥50 copies per mL (Snapshot, intention-to-treat exposed), with a non-inferiority margin of 4%. The trial is registered at ClinicalTrials.gov, NCT03299049 and is ongoing. FINDINGS Screening occurred between Oct 27, 2017, and May 31, 2018. Of 1149 individuals screened, 1045 participants were randomised to the every 8 weeks (n=522) or every 4 weeks (n=523) groups; 37% (n=391) transitioned from every 4 weeks cabotegravir plus rilpivirine long-acting in ATLAS. Median participant age was 42 years (IQR 34-50); 27% (n=280) female at birth; 73% (n=763) white race. Cabotegravir plus rilpivirine long-acting every 8 weeks was non-inferior to dosing every 4 weeks (HIV-1 RNA ≥50 copies per mL; 2% vs 1%) with an adjusted treatment difference of 0·8 (95% CI -0·6-2·2). There were eight (2%, every 8 weeks group) and two (<1%, every 4 weeks group) confirmed virological failures (two sequential measures ≥200 copies per mL). For the every 8 weeks group, five (63%) of eight had archived non-nucleoside reverse transcriptase inhibitor resistance-associated mutations to rilpivirine at baseline. The safety profile was similar between dosing groups, with 844 (81%) of 1045 participants having adverse events (excluding injection site reactions); no treatment-related deaths occurred. INTERPRETATION The efficacy and safety profiles of dosing every 8 weeks and dosing every 4 weeks were similar. These results support the use of cabotegravir plus rilpivirine long-acting administered every 2 months as a therapeutic option for people living with HIV-1. FUNDING ViiV Healthcare and Janssen.
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Affiliation(s)
| | | | - Giuliano Rizzardini
- Fatebenefratelli Sacco Hospital, Milan, Italy; School of Clinical Medicine, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Hans Jaeger
- MVZ Karlsplatz, HIV Research and Clinical Care Centre, Munich, Germany
| | - Catherine Orrell
- Desmond Tutu HIV Foundation, University of Cape Town Medical School, Cape Town, South Africa
| | - Firaya Nagimova
- Republic Center for the Prevention and Control of AIDS and Infectious Diseases, Russia
| | | | | | | | | | - Alexander Wong
- Department of Medicine, University of Saskatchewan, Regina, Saskatchewan, Canada
| | | | | | - Veerle van Eygen
- Janssen Research and Development, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Herta Crauwels
- Janssen Research and Development, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Susan Ford
- GlaxoSmithKline, Research Triangle Park, NC, USA
| | | | | | | | | | | | - Amy Cutrell
- ViiV Healthcare, Research Triangle Park, NC, USA
| | - Parul Patel
- ViiV Healthcare, Research Triangle Park, NC, USA
| | - Mark Shaefer
- ViiV Healthcare, Research Triangle Park, NC, USA
| | | | | | - Simon Vanveggel
- Janssen Research and Development, Janssen Pharmaceutica NV, Beerse, Belgium
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13
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Patel P, Ford SL, Baker M, Meyer C, Garside L, D’Amico R, Van Solingen-Ristea R, Crauwels H, Polli J, Seal C, Thiagarajah S, Birmingham E, Spreen W, Baugh B, Bosse M, Vannappagari V. 885. Pregnancy Outcomes and Pharmacokinetics in Pregnant Women Living with HIV Exposed to Long-Acting Cabotegravir and Rilpivirine in Clinical Trials. Open Forum Infect Dis 2021. [PMCID: PMC8644735 DOI: 10.1093/ofid/ofab466.1080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Limited data exist among women living with HIV who become pregnant while exposed to long-acting (LA) cabotegravir (CAB) and rilpivirine (RPV). We report outcomes in pregnant participants and LA pharmacokinetic (PK) tail data in pregnant women exposed to CAB+RPV with live births. Methods Women of reproductive potential exposed to ≥ 1 dose of CAB+RPV (oral/LA) from ViiV-sponsored Phase 2/3/3b clinical treatment studies and the compassionate use program were included in this analysis and pregnancies identified. Per protocol, upon identification of pregnancy, CAB+RPV was discontinued and an alternative regimen initiated, with continued quarterly PK sampling for 52 weeks post last injection during long-term safety follow-up (LTFU). Descriptive characteristics of pregnant women and birth outcomes and available CAB and RPV PK during pregnancy for those with live births are summarized. Results As of March 31, 2021, 26/325 women of reproductive potential (age 18–49 years) became pregnant while exposed to CAB+RPV (5 oral, 21 LA [including 3 following LA discontinuation]). There were 11 live births (1 oral, 10 LA), of which 10 had no reported congenital abnormalities and 1 had reported congenital ptosis, in a pre-term infant with intrauterine growth restriction. There were 9 elective terminations and 6 miscarriages (5 in first 9 weeks of gestation). Ten women exposed to intramuscular CAB+RPV LA became pregnant with subsequent live birth outcomes, including 3 infants conceived during the PK tail in LTFU. All women were virologically suppressed at time of pregnancy identification. In women becoming pregnant on LA dosing, plasma CAB and RPV concentrations during pregnancy were within the range of expected concentrations in non-pregnant women. Two of 10 women with live births exposed to CAB+RPV LA continued LA therapy during pregnancy (compassionate use program participants). Conclusion Pregnancy outcomes in women exposed to CAB+RPV at conception are consistent with earlier findings. There was 1 reported congenital anomaly among 11 live births. CAB and RPV PK tail in pregnancy was within the expected range for non-pregnant women. Ongoing monitoring of birth defects within the antiretroviral pregnancy registry and pregnancy surveillance within the treatment program continues. Disclosures Parul Patel, PharmD, GlaxoSmithKline (Shareholder)ViiV Healthcare (Employee) Susan L. Ford, PharmD, GlaxoSmithKline (Shareholder)ViiV Healthcare (Employee) Mark Baker, PhD, GlaxoSmithKline (Shareholder)ViiV Healthcare (Employee) Claudia Meyer, MBChB, MRCP, MSc, FRCPath, DTM&H, GlaxoSmithKline (Employee, Shareholder) Louise Garside, PhD, GlaxoSmithKline (Employee) Ronald D’Amico, DO, MSc, GlaxoSmithKline (Shareholder)ViiV Healthcare (Employee) Rodica Van Solingen-Ristea, MD, Janssen Research and Development (Employee)ViiV Healthcare (Employee) Herta Crauwels, PhD, Janssen (Employee) Joseph Polli, PhD, FAAPS, GlaxoSmithKline (Shareholder)ViiV Healthcare (Employee) Ciara Seal, BS, GlaxoSmithKline (Employee, Shareholder) Shanker Thiagarajah, MB ChB, GlaxoSmithKline (Employee, Shareholder) Eileen Birmingham, MD, MPH, Janssen Research and Development (Employee, Shareholder) William Spreen, PharmD, GlaxoSmithKline (Shareholder)ViiV Healthcare (Employee) Bryan Baugh, MD, Janssen, Johnson & Johnson (Employee, Shareholder) Matthew Bosse, DO, GlaxoSmithKline (Shareholder)ViiV Healthcare (Employee) Vani Vannappagari, MBBS, MPH, PhD, ViiV Healthcare Limited (Employee)
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Affiliation(s)
| | | | - Mark Baker
- ViiV Healthcare, Research Triangle Park, NC
| | | | | | | | | | - Herta Crauwels
- Janssen Research and Development, Antwerpen, Oost-Vlaanderen, Belgium
| | | | - Ciara Seal
- GlaxoSmithKline, Research Triangle Park, NC
| | | | - Eileen Birmingham
- Janssen Research and Development, Antwerpen, Oost-Vlaanderen, Belgium
| | | | - Bryan Baugh
- Janssen Research & Development, LLC, Beerse, Antwerpen, Belgium
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14
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Jaeger H, Overton ET, Richmond G, Rizzardini G, Andrade-Villanueva JF, Mngqibisa R, Hermida AO, Thalme A, Belonosova E, Ajana F, Benn PD, Wang Y, Hudson KJ, Español CM, Ford SL, Crauwels H, Margolis DA, Talarico CL, Smith KY, van Eygen V, Van Solingen-Ristea R, Vanveggel S, Spreen WR. Long-acting cabotegravir and rilpivirine dosed every 2 months in adults with HIV-1 infection (ATLAS-2M), 96-week results: a randomised, multicentre, open-label, phase 3b, non-inferiority study. Lancet HIV 2021; 8:e679-e689. [PMID: 34648734 DOI: 10.1016/s2352-3018(21)00185-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/23/2021] [Accepted: 08/02/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Long-acting cabotegravir and rilpivirine administered monthly or every 2 months might address the challenges associated with daily oral antiretroviral therapy. The ATLAS-2M week 48 results showed non-inferiority of long-acting cabotegravir and rilpivirine administered every 8 weeks compared with that of every 4 weeks. In this study, we report the efficacy, safety, and tolerability results from the week 96 analysis. METHODS ATLAS-2M is a randomised, multicentre, open-label, phase 3b, non-inferiority trial conducted in 13 countries, evaluating the safety and efficacy of maintenance treatment with intramuscular injections of long-acting cabotegravir and rilpivirine, administered every 8 weeks versus every 4 weeks, to people living with HIV-1. Virologically suppressed adults with HIV-1, either already receiving intramuscular long-acting cabotegravir and rilpivirine every 4 weeks (ie, ATLAS study rollover participants) or oral standard of care, were randomly assigned (1:1), in an unblinded fashion, to receive either intramuscular long-acting cabotegravir (600 mg) and rilpivirine (900 mg) every 8 weeks (ie, the every 8-week dosing group) or intramuscular long-acting cabotegravir (400 mg) and rilpivirine (600 mg) every 4 weeks (ie, the every 4-week dosing group). Randomisation was generated using the GlaxoSmithKline-validated randomisation software RANDALL NG (version 1.3.3). The primary endpoint at week 48 was the proportion of participants with plasma HIV-1 RNA measurements of 50 copies per mL or more (ie, the US Food and Drug Administration [FDA] Snapshot algorithm), which has been published previously. Here, we present the week 96 results: the proportion of participants with plasma HIV-1 RNA measurements of less than 50 copies per mL (FDA Snapshot algorithm), with a non-inferiority margin of -10%; the proportion of participants with plasma HIV-1 RNA measurements of 50 copies per mL or more (FDA Snapshot algorithm), with a non-inferiority margin of 4%; the proportion of participants with protocol-defined confirmed virological failure (ie, two consecutive plasma HIV-1 RNA measurements ≥200 copies per mL); safety; pharmacokinetics; and tolerability. This study is registered with ClinicalTrials.gov, number NCT03299049, and is currently ongoing. FINDINGS Between Oct 27, 2017, and May 31, 2018, a total of 1149 participants were screened; of whom, 1049 (91%) were randomly assigned and 1045 (91%) initiated treatment (522 in the every 8-week dosing group and 523 in the every 4-week dosing group). The median age was 42 years (IQR 34-50). 280 (27%) of 1045 participants were assigned female at birth and 764 (73%) were white. At week 96 (FDA Snapshot algorithm), 11 (2%) of 522 participants in the every 8-week dosing group and six (1%) of 523 in the every 4-week dosing group had an HIV-1 RNA measurement of 50 copies per mL or more, with an adjusted treatment difference of 1·0 (95% CI -0·6 to 2·5), meeting the prespecified non-inferiority threshold of 4%; 475 (91%) of 522 participants in the every 8-week dosing group and 472 (90%) of 523 in the every 4-week dosing group maintained an HIV-1 RNA measurement of less than 50 copies per mL, with an adjusted treatment difference of 0·8 (95% CI -2·8 to 4·3), which met the prespecified non-inferiority threshold of -10%. One participant in the every 8-week dosing group met the confirmed virological failure criterion since the week 48 analysis at week 88, resulting in a total of nine participants in the every 8-week dosing group and two in the every 4-week dosing group having confirmed virological failure. No new safety signals were identified, and no treatment-related deaths occurred. Injection site reactions were the most common adverse event, occurring in 412 (79%) of 522 participants in the every 8-week dosing group and 400 (76%) of 523 in the every 4-week dosing group. Most injection site reactions were grade 1 or 2 (7453 [99%] of 7557 in both groups), with a median duration of 3 days (IQR 2-5). INTERPRETATION Long-acting cabotegravir and rilpivirine dosed every 8 weeks had non-inferior efficacy compared with that of every 4 weeks through the 96-week analysis, with both regimens maintaining high levels of virological suppression. These results show the durable safety, efficacy, and acceptability of dosing long-acting cabotegravir and rilpivirine monthly and every 2 months as maintenance therapy for people living with HIV-1. FUNDING ViiV Healthcare and Janssen Research & Development.
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Affiliation(s)
- Hans Jaeger
- MVZ Karlsplatz, HIV Research and Clinical Care Centre, Munich, Germany.
| | - Edgar T Overton
- 1917 Clinic, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gary Richmond
- Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Giuliano Rizzardini
- Fatebenefratelli Sacco Hospital, Milan, Italy; School of Clinical Medicine, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Rosie Mngqibisa
- Durban International Clinical Research Site, Enhancing Care Foundation, Wentworth Hospital, Durban, South Africa
| | - Antonio Ocampo Hermida
- Department of Internal Medicine, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Anders Thalme
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Elena Belonosova
- Regional Center for Prevention and Treatment of Acquired Immunodeficiency Syndrome and Infectious Diseases, Orel, Russia
| | - Faïza Ajana
- Centre Hospitalier de Tourcoing, Tourcoing, France
| | | | | | | | | | - Susan L Ford
- GlaxoSmithKline, Research Triangle Park, NC, USA
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15
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Ohta K, Matsushima N, Tanii H, Crauwels H, Kudo T, Ito K. Pharmacokinetics and safety of rilpivirine in healthy Japanese subjects and exploration of ethnic sensitivity of rilpivirine pharmacokinetics with physiologically based pharmacokinetic model approach. Drug Metab Pharmacokinet 2021; 41:100422. [PMID: 34717268 DOI: 10.1016/j.dmpk.2021.100422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/02/2021] [Accepted: 09/16/2021] [Indexed: 11/18/2022]
Abstract
Rilpivirine is a non-nucleoside reverse transcriptase inhibitor, used for the treatment of human immunodeficiency virus type-1 infection. An open label study was conducted to investigate the pharmacokinetics (PK) and safety of a single oral dose of rilpivirine 25 mg in Japanese healthy adult subjects. No adverse events were reported. The mean Cmax (144.3 ng/mL) and AUCinf (4542 ng h/mL) in Japanese subjects were approximately 30 % higher than those reported from a similar study in Caucasian healthy subjects, whereas the median tmax and mean t1/2 values were comparable between studies. A simple physiologically based PK model was developed to characterize the rilpivirine PK profile. The model adequately described rilpivirine PK profiles, and well-predicted drug-drug interactions. With exploration using the model, body size and CYP3A4 abundance were identified as factors which explained the observed inter-ethnic difference in rilpivirine exposure. The inter-ethnic difference in rilpivirine exposure was however considered not clinically relevant, since inter-individual variabilities of those intrinsic factors are larger than inter-ethnic ones; and the observed AUCinf in Japanese subjects was within the range of AUCtau associated with efficacy and safety in Phase 3 studies. This study results support the use of rilpivirine without dose modification specific to Japanese patients.
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Affiliation(s)
- Kentaro Ohta
- Research and Development, Janssen Pharmaceutical K.K., Tokyo, Japan; Research Institute of Pharmaceutical Sciences, Musashino University, Tokyo, Japan.
| | | | - Hiromi Tanii
- Research and Development, Janssen Pharmaceutical K.K., Tokyo, Japan
| | - Herta Crauwels
- Janssen Research and Development, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Toshiyuki Kudo
- Research Institute of Pharmaceutical Sciences, Musashino University, Tokyo, Japan
| | - Kiyomi Ito
- Research Institute of Pharmaceutical Sciences, Musashino University, Tokyo, Japan
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16
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Cutrell AG, Schapiro JM, Perno CF, Kuritzkes DR, Quercia R, Patel P, Polli JW, Dorey D, Wang Y, Wu S, Van Eygen V, Crauwels H, Ford SL, Baker M, Talarico CL, Clair MS, Jeffrey J, White CT, Vanveggel S, Vandermeulen K, Margolis DA, Aboud M, Spreen WR, van Lunzen J. Exploring predictors of HIV-1 virologic failure to long-acting cabotegravir and rilpivirine: a multivariable analysis. AIDS 2021; 35:1333-1342. [PMID: 33730748 PMCID: PMC8270504 DOI: 10.1097/qad.0000000000002883] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/26/2021] [Accepted: 03/03/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Efficacy and safety of long-acting cabotegravir (CAB) and rilpivirine (RPV) dosed intramuscularly every 4 or 8 weeks has been demonstrated in three Phase 3 trials. Here, factors associated with virologic failure at Week 48 were evaluated post hoc. DESIGN AND METHODS Data from 1039 adults naive to long-acting CAB+RPV were pooled in a multivariable analysis to examine the influence of baseline viral and participant factors, dosing regimen and drug concentrations on confirmed virologic failure (CVF) occurrence using a logistic regression model. In a separate model, baseline factors statistically associated with CVF were further evaluated to understand CVF risk when present alone or in combination. RESULTS Overall, 1.25% (n = 13/1039) of participants experienced CVF. Proviral RPV resistance-associated mutations (RAMs), HIV-1 subtype A6/A1, higher BMI (associated with Week 8 CAB trough concentration) and lower Week 8 RPV trough concentrations were significantly associated (P < 0.05) with increased odds of CVF (all except RPV trough are knowable at baseline). Few participants (0.4%) with zero or one baseline factor had CVF. Only a combination of at least two baseline factors (observed in 3.4%; n = 35/1039) was associated with increased CVF risk (25.7%, n = 9/35). CONCLUSION CVF is an infrequent multifactorial event, with a rate of approximately 1% in the long-acting CAB+RPV arms across Phase 3 studies (FLAIR, ATLAS and ATLAS-2M) through Week 48. Presence of at least two of proviral RPV RAMs, HIV-1 subtype A6/A1 and/or BMI at least 30 kg/m2 was associated with increased CVF risk. These findings support the use of long-acting CAB+RPV in routine clinical practice.
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Affiliation(s)
- Amy G. Cutrell
- ViiV Healthcare, Research Triangle Park, North Carolina, USA
| | | | | | - Daniel R. Kuritzkes
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Parul Patel
- ViiV Healthcare, Research Triangle Park, North Carolina, USA
| | - Joseph W. Polli
- ViiV Healthcare, Research Triangle Park, North Carolina, USA
| | - David Dorey
- GlaxoSmithKline, Mississauga, Ontario, Canada
| | | | - Sterling Wu
- GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | | | | | - Susan L. Ford
- GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | | | | | - Marty St Clair
- ViiV Healthcare, Research Triangle Park, North Carolina, USA
| | - Jerry Jeffrey
- ViiV Healthcare, Research Triangle Park, North Carolina, USA
| | - C. Thomas White
- ViiV Healthcare, Research Triangle Park, North Carolina, USA
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17
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Letendre SL, Mills A, Hagins D, Swindells S, Felizarta F, Devente J, Bettacchi C, Lou Y, Ford S, Sutton K, Shaik JS, Crauwels H, D'Amico R, Patel P. Pharmacokinetics and antiviral activity of cabotegravir and rilpivirine in cerebrospinal fluid following long-acting injectable administration in HIV-infected adults. J Antimicrob Chemother 2021; 75:648-655. [PMID: 31873746 PMCID: PMC7021098 DOI: 10.1093/jac/dkz504] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/31/2019] [Accepted: 11/05/2019] [Indexed: 12/18/2022] Open
Abstract
Background Long-acting (LA) formulations of cabotegravir, an HIV integrase inhibitor, and rilpivirine, an NNRTI, are in development as monthly or 2 monthly intramuscular (IM) injections for maintenance of virological suppression. Objectives To evaluate cabotegravir and rilpivirine CSF distribution and HIV-1 RNA suppression in plasma and CSF in HIV-infected adults participating in a substudy of the Phase 2b LATTE-2 study (NCT02120352). Methods Eighteen participants receiving cabotegravir LA 400 mg + rilpivirine LA 600 mg IM [every 4 weeks (Q4W), n = 3] or cabotegravir LA 600 mg + rilpivirine LA 900 mg IM [every 8 weeks (Q8W), n = 15] with plasma HIV-1 RNA <50 copies/mL enrolled. Paired steady-state CSF and plasma concentrations were evaluable in 16 participants obtained 7 (±3) days after an injection visit. HIV-1 RNA in CSF and plasma were assessed contemporaneously using commercial assays. Results Median total CSF concentrations in Q4W and Q8W groups, respectively, were 0.011 μg/mL and 0.013 μg/mL for cabotegravir (0.30% and 0.34% of the paired plasma concentrations) and 1.84 ng/mL and 1.67 ng/mL for rilpivirine (1.07% and 1.32% of paired plasma concentrations). Cabotegravir and rilpivirine total CSF concentrations exceeded their respective in vitro EC50 for WT HIV-1 (0.10 ng/mL and 0.27 ng/mL, respectively). All 16 participants had HIV-1 RNA <50 copies/mL in plasma and CSF, and 15 of 16 participants had HIV-1 RNA <2 copies/mL in CSF. Conclusions A dual regimen of cabotegravir LA and rilpivirine LA achieved therapeutic concentrations in the CSF resulting in effective virological control in CSF.
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Affiliation(s)
| | | | | | | | | | - Jerome Devente
- Long Beach Education and Research Consultants, Long Beach, CA, USA
| | | | - Yu Lou
- PAREXEL International, Durham, NC, USA
| | - Susan Ford
- GlaxoSmithKline, Research Triangle Park, NC, USA
| | | | | | | | | | - Parul Patel
- ViiV Healthcare, Research Triangle Park, NC, USA
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18
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Orkin C, Oka S, Philibert P, Brinson C, Bassa A, Gusev D, Degen O, García JG, Morell EB, Tan DHS, D'Amico R, Dorey D, Griffith S, Thiagarajah S, St Clair M, Van Solingen-Ristea R, Crauwels H, Ford SL, Patel P, Chounta V, Vanveggel S, Cutrell A, Van Eygen V, Vandermeulen K, Margolis DA, Smith KY, Spreen WR. Long-acting cabotegravir plus rilpivirine for treatment in adults with HIV-1 infection: 96-week results of the randomised, open-label, phase 3 FLAIR study. Lancet HIV 2021; 8:e185-e196. [PMID: 33794181 DOI: 10.1016/s2352-3018(20)30340-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/04/2020] [Accepted: 12/10/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is a need for more convenient, less frequent treatment to help address challenges associated with daily oral HIV treatment in people living with HIV, including stigma, pill burden, drug-food interactions, and adherence. The phase 3 ATLAS and FLAIR studies showed non-inferiority of long-acting cabotegravir and rilpivirine dosed every 4 weeks compared with standard oral therapy for the maintenance of virological suppression in adults with HIV-1 over 48 weeks. We present the 96-week findings. METHODS FLAIR is a randomised, phase 3, open-label, multicentre study done in 11 countries investigating whether switching to long-acting cabotegravir and rilpivirine is non-inferior to daily dolutegravir, abacavir, and lamivudine in virologically suppressed adults living with HIV-1. Antiretroviral therapy (ART)-naive participants received induction therapy with daily oral dolutegravir (50 mg), abacavir (600 mg), and lamivudine (300 mg) for 20 weeks. After 16 weeks, participants with less than 50 HIV-1 RNA copies per mL were randomly assigned (1:1) to continue the standard of care regimen (standard care group) or switch to receive daily oral cabotegravir 30 mg and rilpivirine 25 mg for at least 4 weeks followed by long-acting cabotegravir 400 mg and rilpivirine 600 mg, administered as two 2 mL intramuscular injections, every 4 weeks for at least 96 weeks (long-acting group). Randomisation was stratified by baseline (preinduction) HIV-1 RNA (<100 000 or ≥100 000 copies per mL) and sex at birth and used GlaxoSmithKline-verified randomisation software (RandAll NG, version 1.3.3) for treatment assignment. The primary endpoint was the proportion of participants with plasma HIV-1 RNA of 50 copies per mL or more assessed as per the US Food and Drug Administration (FDA) Snapshot algorithm at week 48, which has been reported previously. Here, we report the proportion of participants with 50 or more HIV-1 RNA copies per mL using the FDA Snapshot algorithm at week 96 (intention-to-treat population; non-inferiority margin 6%). The trial is registered with ClinicalTrials.gov, NCT02938520. FINDINGS Between Oct 27, 2016, and March 24, 2017, 809 participants were screened. 631 (78%) participants entered the induction phase and 566 (70%) were randomly assigned to either the standard care group (283 [50%] participants) or the long-acting group (283 [50%]). Median age was 34 years (IQR 29 to 43), 62 (11%) were 50 years or older, 127 (22%) were women (sex at birth), and 419 (74%) were white. At week 96, nine (3%) participants in each arm had 50 or more HIV-1 RNA copies per mL, with an adjusted difference of 0·0 (95% CI -2·9 to 2·9), consistent with non-inferiority established at week 48. Across both treatment groups, adverse events leading to withdrawal were infrequent (14 [5%] participants in the long-acting group and four [1%] in the standard care group). Injection site reactions were the most common adverse event, reported by 245 (88%) participants in the long-acting group; their frequency decreased over time. Median injection site reaction duration was 3 days (IQR 2 to 4), and 3082 (99%) of 3100 reactions were grade 1 or 2. No deaths occurred during the maintenance phase. INTERPRETATION The 96-week results reaffirm the 48-week results, showing long-acting cabotegravir and rilpivirine continued to be non-inferior compared with continuing a standard care regimen in adults with HIV-1 for the maintenance of viral suppression. These results support the durability of long-acting cabotegravir and rilpivirine, over an almost 2-year-long period, as a therapeutic option for virally suppressed adults with HIV-1. FUNDING ViiV Healthcare and Janssen Research and Development.
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Affiliation(s)
- Chloe Orkin
- Department of Immunobiology, Queen Mary University, London, UK.
| | - Shinichi Oka
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Patrick Philibert
- Department for Internal Medicine and Infectious Diseases, Hôpital Européen, Marseille, France
| | | | - Ayesha Bassa
- Mzansi Ethical Research Centre, Middelburg, South Africa
| | - Denis Gusev
- State Medical Center for the Prevention and Control of AIDS and Infectious Diseases, St Petersburg, Russia; St Petersburg State Budgetary Health Care Institution, St Petersburg, Russia
| | - Olaf Degen
- Infectious Diseases Unit, Outpatient Center, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Juan González García
- Department for Internal Medicine, Hospital La Paz Institute for Health Research, Hospital Universitario La Paz, Madrid, Spain
| | - Enrique Bernal Morell
- Sección de Enfermedades Infecciosas, Hospital General Universitario Reina Sofía, Murcia, Spain
| | - Darrell H S Tan
- Division of Infectious Diseases, Department of Medicine, St Michael's Hospital, Toronto, ON, Canada
| | - Ronald D'Amico
- Research and Development, ViiV Healthcare, Research Triangle Park, NC, USA
| | - David Dorey
- Biostatistics, GlaxoSmithKline, Mississauga, ON, Canada
| | - Sandy Griffith
- Research and Development, ViiV Healthcare, Research Triangle Park, NC, USA
| | | | - Marty St Clair
- Translational Medical Research, ViiV Healthcare, Research Triangle Park, NC, USA
| | | | - Herta Crauwels
- Infectious Diseases & Vaccines, Janssen Research & Development, Beerse, Belgium
| | - Susan L Ford
- Clinical Pharmacology, GlaxoSmithKline, Research Triangle Park, NC, USA
| | - Parul Patel
- Research and Development, ViiV Healthcare, Research Triangle Park, NC, USA
| | | | - Simon Vanveggel
- Global Development, Janssen Research & Development, Beerse, Belgium
| | - Amy Cutrell
- Research Statistics, ViiV Healthcare, Research Triangle Park, NC, USA
| | - Veerle Van Eygen
- Infectious Diseases & Vaccines, Janssen Research & Development, Beerse, Belgium
| | - Kati Vandermeulen
- Infectious Diseases & Vaccines, Janssen Research & Development, Beerse, Belgium
| | - David A Margolis
- Research and Development, ViiV Healthcare, Research Triangle Park, NC, USA
| | - Kimberly Y Smith
- Research and Development, ViiV Healthcare, Research Triangle Park, NC, USA
| | - William R Spreen
- Research and Development, ViiV Healthcare, Research Triangle Park, NC, USA
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19
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Mehta R, Piscitelli J, Wolstenholme A, Fu C, Crauwels H, Wynne B, Adkison K. The Effect of Moderate- and High-Fat Meals on the Bioavailability of Dolutegravir/Rilpivirine Fixed-Dose Combination Tablet. Clin Pharmacol 2020; 12:49-52. [PMID: 32607002 PMCID: PMC7292371 DOI: 10.2147/cpaa.s250751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/19/2020] [Indexed: 11/27/2022] Open
Abstract
Dolutegravir 50 mg (DTG) and rilpivirine 25 mg (RPV) are a newly approved 2-drug regimen for the treatment of HIV in virally suppressed patients. A 2-part study evaluated the relative bioavailability and food effect of five experimental fixed-dose combination (FDC) tablet formulations of DTG/RPV. When given with a moderate- or high-fat meal, the absorption of both DTG and RPV was increased, resulting in higher exposures. As per product labelling, DTG/RPV FDC should be taken with a meal.
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Affiliation(s)
- Rashmi Mehta
- GlaxoSmithKline, Research Triangle Park, NC, USA
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20
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Orkin C, Arasteh K, Górgolas Hernández-Mora M, Pokrovsky V, Overton ET, Girard PM, Oka S, Walmsley S, Bettacchi C, Brinson C, Philibert P, Lombaard J, St Clair M, Crauwels H, Ford SL, Patel P, Chounta V, D'Amico R, Vanveggel S, Dorey D, Cutrell A, Griffith S, Margolis DA, Williams PE, Parys W, Smith KY, Spreen WR. Long-Acting Cabotegravir and Rilpivirine after Oral Induction for HIV-1 Infection. N Engl J Med 2020; 382:1124-1135. [PMID: 32130806 DOI: 10.1056/nejmoa1909512] [Citation(s) in RCA: 202] [Impact Index Per Article: 50.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Long-acting injectable regimens may simplify therapy for patients with human immunodeficiency virus type 1 (HIV-1) infection. METHODS We conducted a phase 3, randomized, open-label trial in which adults with HIV-1 infection who had not previously received antiretroviral therapy were given 20 weeks of daily oral induction therapy with dolutegravir-abacavir-lamivudine. Participants who had an HIV-1 RNA level of less than 50 copies per milliliter after 16 weeks were randomly assigned (1:1) to continue the current oral therapy or switch to oral cabotegravir plus rilpivirine for 1 month followed by monthly injections of long-acting cabotegravir plus rilpivirine. The primary end point was the percentage of participants who had an HIV-1 RNA level of 50 copies per milliliter or higher at week 48 (Food and Drug Administration snapshot algorithm). RESULTS At week 48, an HIV-1 RNA level of 50 copies per milliliter or higher was found in 6 of 283 participants (2.1%) who received long-acting therapy and in 7 of 283 (2.5%) who received oral therapy (adjusted difference, -0.4 percentage points; 95% confidence interval [CI], -2.8 to 2.1), a result that met the criterion for noninferiority for the primary end point (margin, 6 percentage points). An HIV-1 RNA level of less than 50 copies per milliliter at week 48 was found in 93.6% who received long-acting therapy and in 93.3% who received oral therapy (adjusted difference, 0.4 percentage points; 95% CI, -3.7 to 4.5), a result that met the criterion for noninferiority for this end point (margin, -10 percentage points). Of the participants who received long-acting therapy, 86% reported injection-site reactions (median duration, 3 days; mild or moderate severity, 99% of cases); 4 participants withdrew from the trial for injection-related reasons. Grade 3 or higher adverse events and events that met liver-related stopping criteria occurred in 11% and 2%, respectively, who received long-acting therapy and in 4% and 1% who received oral therapy. Treatment satisfaction increased after participants switched to long-acting therapy; 91% preferred long-acting therapy at week 48. CONCLUSIONS Therapy with long-acting cabotegravir plus rilpivirine was noninferior to oral therapy with dolutegravir-abacavir-lamivudine with regard to maintaining HIV-1 suppression. Injection-site reactions were common. (Funded by ViiV Healthcare and Janssen; FLAIR ClinicalTrials.gov number, NCT02938520.).
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Affiliation(s)
- Chloe Orkin
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Keikawus Arasteh
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Miguel Górgolas Hernández-Mora
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Vadim Pokrovsky
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Edgar T Overton
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Pierre-Marie Girard
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Shinichi Oka
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Sharon Walmsley
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Chris Bettacchi
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Cynthia Brinson
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Patrick Philibert
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Johan Lombaard
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Marty St Clair
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Herta Crauwels
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Susan L Ford
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Parul Patel
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Vasiliki Chounta
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Ronald D'Amico
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Simon Vanveggel
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - David Dorey
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Amy Cutrell
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Sandy Griffith
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - David A Margolis
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Peter E Williams
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Wim Parys
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Kimberly Y Smith
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - William R Spreen
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
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Swindells S, Andrade-Villanueva JF, Richmond GJ, Rizzardini G, Baumgarten A, Masiá M, Latiff G, Pokrovsky V, Bredeek F, Smith G, Cahn P, Kim YS, Ford SL, Talarico CL, Patel P, Chounta V, Crauwels H, Parys W, Vanveggel S, Mrus J, Huang J, Harrington CM, Hudson KJ, Margolis DA, Smith KY, Williams PE, Spreen WR. Long-Acting Cabotegravir and Rilpivirine for Maintenance of HIV-1 Suppression. N Engl J Med 2020; 382:1112-1123. [PMID: 32130809 DOI: 10.1056/nejmoa1904398] [Citation(s) in RCA: 236] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Simplified regimens for the treatment of human immunodeficiency virus type 1 (HIV-1) infection may increase patient satisfaction and facilitate adherence. METHODS In this phase 3, open-label, multicenter, noninferiority trial involving patients who had had plasma HIV-1 RNA levels of less than 50 copies per milliliter for at least 6 months while taking standard oral antiretroviral therapy, we randomly assigned participants (1:1) to either continue their oral therapy or switch to monthly intramuscular injections of long-acting cabotegravir, an HIV-1 integrase strand-transfer inhibitor, and long-acting rilpivirine, a nonnucleoside reverse-transcriptase inhibitor. The primary end point was the percentage of participants with an HIV-1 RNA level of 50 copies per milliliter or higher at week 48, determined with the use of the Food and Drug Administration snapshot algorithm. RESULTS Treatment was initiated in 308 participants per group. At week 48, HIV-1 RNA levels of 50 copies per milliliter or higher were found in 5 participants (1.6%) receiving long-acting therapy and in 3 (1.0%) receiving oral therapy (adjusted difference, 0.6 percentage points; 95% confidence interval [CI], -1.2 to 2.5), a result that met the criterion for noninferiority for the primary end point (noninferiority margin, 6 percentage points). An HIV-1 RNA level of less than 50 copies per milliliter at week 48 was found in 92.5% of participants receiving long-acting therapy and in 95.5% of those receiving oral therapy (adjusted difference, -3.0 percentage points; 95% CI, -6.7 to 0.7), a result that met the criterion for noninferiority for this end point (noninferiority margin, -10 percentage points). Virologic failure was confirmed in 3 participants who received long-acting therapy and 4 participants who received oral therapy. Adverse events were more common in the long-acting-therapy group and included injection-site pain, which occurred in 231 recipients (75%) of long-acting therapy and was mild or moderate in most cases; 1% withdrew because of this event. Serious adverse events were reported in no more than 5% of participants in each group. CONCLUSIONS Monthly injections of long-acting cabotegravir and rilpivirine were noninferior to standard oral therapy for maintaining HIV-1 suppression. Injection-related adverse events were common but only infrequently led to medication withdrawal. (Funded by ViiV Healthcare and Janssen; ATLAS ClinicalTrials.gov number, NCT02951052.).
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Affiliation(s)
- Susan Swindells
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Jaime-Federico Andrade-Villanueva
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Gary J Richmond
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Giuliano Rizzardini
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Axel Baumgarten
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Mar Masiá
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Gulam Latiff
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Vadim Pokrovsky
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Fritz Bredeek
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Graham Smith
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Pedro Cahn
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Yeon-Sook Kim
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Susan L Ford
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Christine L Talarico
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Parul Patel
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Vasiliki Chounta
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Herta Crauwels
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Wim Parys
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Simon Vanveggel
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Joseph Mrus
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Jenny Huang
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Conn M Harrington
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Krischan J Hudson
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - David A Margolis
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Kimberly Y Smith
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Peter E Williams
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - William R Spreen
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
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Patel P, Ford SL, Crauwels H, Han K, Rossenu S, Neyens M, Griffith S, Hudson KJ, Margolis D, Baker M, Williams P, Spreen W. 2495. Pharmacokinetics of Cabotegravir (CAB) and Rilpivirine (RPV) Long-Acting (LA) Injectables in HIV-infected Individuals through 48 Weeks in the FLAIR and ATLAS Phase 3 Studies. Open Forum Infect Dis 2019. [PMCID: PMC6809519 DOI: 10.1093/ofid/ofz360.2173] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Monthly injectable CAB LA + RPV LA was noninferior to daily oral 3-drug antiretroviral therapy in HIV-1 virologically suppressed adults. CAB and RPV pharmacokinetics (PK) were assessed during the 48 Week maintenance period of the ATLAS and FLAIR Phase 3 studies. Methods Patients received oral CAB 30 mg + RPV 25 mg once daily for 4 weeks to assess individual tolerability prior to intramuscular (IM) injections of CAB LA 600 mg + RPV LA 900 mg followed by CAB LA 400 mg + RPV LA 600 mg every 4 weeks. Plasma CAB and RPV concentrations were measured pre-and post-dose at select visits using validated analytical methods. Results Baseline demographics for the pooled randomized ATLAS and FLAIR population (n = 591, LA arms) were: median age 38 years, 27% female, 18% African American, median BMI 25 kg/m2 (range: 15 – 51). CAB and RPV plasma concentrations at select visits are summarized in the table. After initial IM doses, mean CAB and RPV troughs were well above their respective in vitro PA-IC90 values (CAB, 0.166 μg/mL; RPV 12 ng/mL). At Week 48, mean CAB troughs were 17x PA-IC90 and between oral CAB 10–30 mg exposures. Similarly, mean RPV troughs were 7x PA-IC90 and remained within the exposure range following oral RPV 25 mg once daily. 80% of RPV steady-state was achieved by Week 48 and 100% for CAB by Week 44. Initial CAB concentrations in females and those with BMI ≥30 kg/m2 were lower due to slower absorption but this difference resolved by Week 48. For RPV, there was no absorption difference by gender or BMI. Conclusion CAB and RPV PK were consistent between studies achieving therapeutic concentrations within the first dosing interval that steadily increased over time through Week 48, for both males and females and irrespective of BMI. CAB LA + RPV LA provided compatible PK profiles following monthly IM dosing in a diverse patient population through 48 weeks. ![]()
Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Parul Patel
- ViiV Healthcare, Research Triangle Park, North Carolina
| | - Susan L Ford
- GlaxoSmithKline, Research Triangle Park, North Carolina
| | - Herta Crauwels
- Janssen Research and Development, Antwerpen, Oost-Vlaanderen, Belgium
| | - Kelong Han
- GlaxoSmithKline, Research Triangle Park, North Carolina
| | - Stefaan Rossenu
- Janssen Research and Development, Antwerpen, Oost-Vlaanderen, Belgium
| | - Martine Neyens
- Janssen Research and Development, Antwerpen, Oost-Vlaanderen, Belgium
| | | | | | | | - Mark Baker
- ViiV Healthcare, Research Triangle Park, North Carolina
| | - Peter Williams
- Janssen Research and Development, Antwerpen, Oost-Vlaanderen, Belgium
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23
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Green B, Crauwels H, Kakuda TN, Vanveggel S, Brochot A. Evaluation of Concomitant Antiretrovirals and CYP2C9/CYP2C19 Polymorphisms on the Pharmacokinetics of Etravirine. Clin Pharmacokinet 2017; 56:525-536. [PMID: 27665573 DOI: 10.1007/s40262-016-0454-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Etravirine is a non-nucleoside reverse transcriptase inhibitor indicated in combination with other antiretrovirals for treatment-experienced HIV patients ≥6 years of age. Etravirine is primarily metabolized by cytochrome P450 (CYP) 2C9, CYP2C19, and CYP3A. This analysis determined the impact of concomitant antiretrovirals and CYP2C9/CYP2C19 phenotype on the pharmacokinetics of etravirine. METHODS We used 4728 plasma concentrations from 817 adult subjects collected from four clinical studies to develop the population pharmacokinetic model. The presence of atazanavir/ritonavir, lopinavir/ritonavir, darunavir/ritonavir, tenofovir disoproxil fumarate, or enfuvirtide together with the CYP2C9 and CYP2C19 phenotype and other demographics were evaluated. RESULTS A one-compartment model with first-order input and a lag-time best described the data. Estimates of apparent total clearance (CL/F), apparent central volume of distribution (V c/F), first-order absorption rate constant (k a), and absorption lag-time were 41.7 L/h, 972 L, 1.16 h, and 1.32 h, respectively. Estimates of between-subject variability on CL/F, V c/F, and relative bioavailability (F) were 39.4 %CV (percentage coefficient of variation), 35.9 %CV and 35.5 %CV, respectively. Between-occasion variability on F was estimated to be 30.0 %CV. CL/F increased non-linearly with body weight and creatinine clearance (CLCR), and also varied based on CYP2C9/CYP2C19 phenotype. CONCLUSIONS In this analysis, body weight, CLCR, and CYP2C9/CYP2C19 phenotype were found to describe some of the variability in CL/F. It was not possible to show an impact of concomitant antiretrovirals on the pharmacokinetics of etravirine for adults predominantly taking coadministered boosted protease inhibitors as a background antiretroviral regimen.
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Affiliation(s)
- Bruce Green
- Model Answers Pty Ltd, Level 5, 99 Creek Street, 4000, Brisbane, QLD, Australia.
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Margolis DA, Gonzalez-Garcia J, Stellbrink HJ, Eron JJ, Yazdanpanah Y, Podzamczer D, Lutz T, Angel JB, Richmond GJ, Clotet B, Gutierrez F, Sloan L, Clair MS, Murray M, Ford SL, Mrus J, Patel P, Crauwels H, Griffith SK, Sutton KC, Dorey D, Smith KY, Williams PE, Spreen WR. Long-acting intramuscular cabotegravir and rilpivirine in adults with HIV-1 infection (LATTE-2): 96-week results of a randomised, open-label, phase 2b, non-inferiority trial. Lancet 2017; 390:1499-1510. [PMID: 28750935 DOI: 10.1016/s0140-6736(17)31917-7] [Citation(s) in RCA: 341] [Impact Index Per Article: 48.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/03/2017] [Accepted: 07/05/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cabotegravir and rilpivirine are antiretroviral drugs in development as long-acting injectable formulations. The LATTE-2 study evaluated long-acting cabotegravir plus rilpivirine for maintenance of HIV-1 viral suppression through 96 weeks. METHODS In this randomised, phase 2b, open-label study, treatment-naive adults infected with HIV-1 initially received oral cabotegravir 30 mg plus abacavir-lamivudine 600-300 mg once daily. The objective of this study was to select an intramuscular dosing regimen based on a comparison of the antiviral activity, tolerability, and safety of the two intramuscular dosing regimens relative to oral cabotegravir plus abacavir-lamivudine. After a 20-week induction period on oral cabotegravir plus abacavir-lamivudine, patients with viral suppression (plasma HIV-1 RNA <50 copies per mL) were randomly assigned (2:2:1) to intramuscular long-acting cabotegravir plus rilpivirine at 4-week intervals (long-acting cabotegravir 400 mg plus rilpivirine 600 mg; two 2 mL injections) or 8-week intervals (long-acting cabotegravir 600 mg plus rilpivirine 900 mg; two 3 mL injections) or continued oral cabotegravir plus abacavir-lamivudine. Randomisation was computer-generated with stratification by HIV-1 RNA (<50 copies per mL, yes or no) during the first 12 weeks of the induction period. The primary endpoints were the proportion of patients with viral suppression at week 32 (as defined by the US Food and Drug Administration snapshot algorithm), protocol-defined virological failures, and safety events through 96 weeks. All randomly assigned patients who received at least one dose of study drug during the maintenance period were included in the primary efficacy and safety analyses. The primary analysis used a Bayesian approach to evaluate the hypothesis that the proportion with viral suppression for each long-acting regimen is not worse than the oral regimen proportion by more than 10% (denoted comparable) according to a prespecified decision rule (ie, posterior probability for comparability >90%). Difference in proportions and associated 95% CIs were supportive to the primary analysis. The trial is registered at ClinicalTrials.gov, number NCT02120352. FINDINGS Among 309 enrolled patients, 286 were randomly assigned to the maintenance period (115 to each of the 4-week and 8-week groups and 56 to the oral treatment group). This study is currently ongoing. At 32 weeks following randomisation, both long-acting regimens met primary criteria for comparability in viral suppression relative to the oral comparator group. Viral suppression was maintained at 32 weeks in 51 (91%) of 56 patients in the oral treatment group, 108 (94%) of 115 patients in the 4-week group (difference 2·8% [95% CI -5·8 to 11·5] vs oral treatment), and 109 (95%) of 115 patients in the 8-week group (difference 3·7% [-4·8 to 12·2] vs oral treatment). At week 96, viral suppression was maintained in 47 (84%) of 56 patients receiving oral treatment, 100 (87%) of 115 patients in the 4-week group, and 108 (94%) of 115 patients in the 8-week group. Three patients (1%) experienced protocol-defined virological failure (two in the 8-week group; one in the oral treatment group). Injection-site reactions were mild (3648 [84%] of 4360 injections) or moderate (673 [15%] of 4360 injections) in intensity and rarely resulted in discontinuation (two [<1%] of 230 patients); injection-site pain was reported most frequently. Serious adverse events during maintenance were reported in 22 (10%) of 230 patients in the intramuscular groups (4-week and 8-week groups) and seven (13%) of 56 patients in the oral treatment group; none were drug related. INTERPRETATION The two-drug combination of all-injectable, long-acting cabotegravir plus rilpivirine every 4 weeks or every 8 weeks was as effective as daily three-drug oral therapy at maintaining HIV-1 viral suppression through 96 weeks and was well accepted and tolerated. FUNDING ViiV Healthcare and Janssen R&D.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Bonaventura Clotet
- Hospital Germans Trias i Pujol, UAB, UVIC-UCC, Badalona, Catalonia, Spain
| | - Felix Gutierrez
- Hospital General de Elche & Universidad Miguel Hernández, Alicante, Spain
| | - Louis Sloan
- North Texas Infectious Disease Consultants, Dallas, TX, USA
| | | | | | - Susan L Ford
- GlaxoSmithKline, Research Triangle Park, NC, USA
| | - Joseph Mrus
- ViiV Healthcare, Research Triangle Park, NC, USA
| | - Parul Patel
- ViiV Healthcare, Research Triangle Park, NC, USA
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Arathoon E, Bhorat A, Silaghi R, Crauwels H, Lavreys L, Tambuyzer L, Van Baelen B, Vanveggel S, Opsomer M. Etravirine combined with antiretrovirals other than darunavir/ritonavir for HIV-1-infected, treatment-experienced adults: Week 48 results of a phase IV trial. SAGE Open Med 2017; 5:2050312116686482. [PMID: 28382208 PMCID: PMC5367767 DOI: 10.1177/2050312116686482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 12/01/2016] [Indexed: 11/21/2022] Open
Abstract
Objective: VIOLIN (TMC125IFD3002; NCT01422330) evaluated the safety, tolerability, and pharmacokinetics of etravirine with antiretrovirals other than darunavir/ritonavir in HIV-1-infected patients. Methods: In a 48-week, phase IV, single-arm, multicenter study, patients on prior antiretroviral therapy (⩾8 weeks) who needed to change regimen for virologic failure (viral load ⩾ 500 copies/mL) or simplification/adverse events (viral load < 50 copies/mL) received etravirine 200 mg bid with ⩾1 other active antiretroviral, excluding darunavir/ritonavir or only nucleoside/tide reverse transcriptase inhibitors. Results: Of 211 treated patients, 73% (n = 155) had baseline viral load ⩾ 50 copies/mL and 27% (n = 56) had baseline viral load < 50 copies/mL. Protease inhibitors were the most common background antiretrovirals (83%). Diarrhea was the most frequent adverse event (17%). Serious adverse events (no rash) occurred in 5% of patients; none were etravirine related. Overall, median etravirine AUC12h was 5390 ng h/mL and C0h was 353 ng/mL (N = 199). Week 48 virologic response rates (viral load < 50 copies/mL; Food and Drug Administration Snapshot algorithm) were 48% (74/155) (baseline viral load ⩾ 50 copies/mL) and 75% (42/56) (baseline viral load < 50 copies/mL). Virologic failure rates were 42% and 13%, respectively. The most frequently emerging etravirine resistance-associated mutations in virologic failures were Y181C, E138A, and M230L. Virologic response rates for patients with baseline viral load ⩾ 50 copies/mL were 38% (30/79) (non-adherent) versus 64% (44/69) (adherent subset). Conclusion: Etravirine 200 mg bid in combination with antiretrovirals other than darunavir/ritonavir was well tolerated in the studied treatment-experienced HIV-1-infected population. The overall etravirine safety and tolerability profile and pharmacokinetics (specifically in those patients who were adherent) were similar to those previously observed for etravirine in HIV-1-infected adults. The relatively high level of non-adherence, also observed in the pharmacokinetic assessments, negatively impacted virologic response, especially in patients with ⩾50 copies/mL at baseline.
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Affiliation(s)
- Eduardo Arathoon
- La Clinica Familiar de Luis Angel Garcia, Guatemala City, Guatemala
| | - Asad Bhorat
- Soweto Clinical Trials Centre, Johannesburg, South Africa
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Kakuda TN, Crauwels H, Opsomer M, Tomaka F, van de Casteele T, Vanveggel S, Iterbeke K, de Smedt G. Darunavir/cobicistat once daily for the treatment of HIV. Expert Rev Anti Infect Ther 2016; 13:691-704. [PMID: 25962100 DOI: 10.1586/14787210.2015.1033400] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A current focus in HIV management is improving adherence by minimizing pill burden with convenient formulations, including fixed-dose combinations (FDCs). Darunavir, a HIV protease inhibitor, co-administered with low-dose ritonavir (800/100 mg once daily), is recommended in guidelines in combination with other antiretrovirals for HIV patients with no darunavir resistance-associated mutations. Cobicistat is an alternative agent to ritonavir for boosting plasma drug levels of darunavir among other antiretrovirals. Cobicistat is a more specific cytochrome P450 3A inhibitor than ritonavir without enzyme-inducing properties. This review describes the differing effects of cobicistat and ritonavir on metabolic enzymes, which explains their differing drug-drug interactions, and summarizes some of the studied drug-drug interactions for cobicistat. It also outlines the clinical development and data for a once-daily darunavir/cobicistat FDC. This FDC thus allows for a once-daily treatment regimen (including background antiretrovirals) with reduced pill burden.
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Verloes R, Deleu S, Niemeijer N, Crauwels H, Meyvisch P, Williams P. Safety, tolerability and pharmacokinetics of rilpivirine following administration of a long-acting formulation in healthy volunteers. HIV Med 2015; 16:477-84. [PMID: 25988676 DOI: 10.1111/hiv.12247] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This phase I healthy volunteer study (NCT01031589) was carried out to investigate the safety/tolerability and pharmacokinetics of a rilpivirine (RPV; TMC278) long-acting (LA) formulation after single and multiple intramuscular (i.m.) injections. METHODS In the first part of the study, which had an open-label design, a single RPV LA i.m. injection (300 mg/mL) of 300 (n = 6) or 600 (n = 5) mg was given to the volunteers. In the second part of the study, which had a double-blind, randomized, placebo-controlled design, three RPV LA i.m. injections (one every 4 weeks) at 1200/600/600 mg (n = 6) or placebo (n = 2) were given. Safety and local tolerability were monitored. RPV plasma concentrations were analysed up to 28 days after injection or until they were < 20 ng/mL. RESULTS Grade 1/2 RPV-related adverse events in the 300, 600 and 1200/600/600 mg groups were: rash (zero, one and one subject, respectively, the last of whom discontinued participation in the study); musculoskeletal stiffness (three, zero and zero subjects, respectively); injection site reactions (one, two and two subjects, respectively). After one injection of 300, 600 or 1200 mg RPV LA, the mean (standard deviation) maximum plasma concentration was 39 (25), 48 (13) and 140 (16) ng/mL, and the mean (standard deviation) area under the concentration-time curve (28 days) was 17,090 (8907), 25,240 (8184) and 55,350 (13,550) ng h/mL, respectively. RPV pharmacokinetics were largely comparable after the 1200 mg loading dose and both 600 mg injections of RPV LA. The mean (standard deviation) RPV plasma concentration across the 28-day dosing interval after the last injection in the 1200/600/600 mg group was 79 (19) ng/mL. CONCLUSIONS Single and multiple i.m. injections of RPV LA demonstrated favourable local/systemic tolerability in healthy volunteers. RPV pharmacokinetics suggested that clinically relevant plasma concentrations can be achieved with this LA formulation.
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Affiliation(s)
- R Verloes
- Janssen Infectious Diseases BVBA, Beerse, Belgium
| | - S Deleu
- Janssen Clinical Pharmacology Unit, Merksem, Belgium
| | - N Niemeijer
- Janssen Infectious Diseases BVBA, Beerse, Belgium
| | - H Crauwels
- Janssen Infectious Diseases BVBA, Beerse, Belgium
| | - P Meyvisch
- Janssen Infectious Diseases BVBA, Beerse, Belgium
| | - P Williams
- Janssen Infectious Diseases BVBA, Beerse, Belgium
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Rossenu S, Cleton A, Hough D, Crauwels H, Vandebosch A, Berwaerts J, Eerdekens M, Herben V, De Meulder M, Remmerie B, Francetic I. Pharmacokinetic profile after multiple deltoid or gluteal intramuscular injections of paliperidone palmitate in patients with schizophrenia. Clin Pharmacol Drug Dev 2014; 4:270-8. [DOI: 10.1002/cpdd.144] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 07/10/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Stefaan Rossenu
- Division of Janssen Pharmaceutica NV; Janssen Research & Development; Beerse Belgium
| | - Adriaan Cleton
- Division of Janssen Pharmaceutica NV; Janssen Research & Development; Beerse Belgium
| | - David Hough
- Janssen Research & Development; LLC; Raritan NJ USA
| | - Herta Crauwels
- Division of Janssen Pharmaceutica NV; Janssen Research & Development; Beerse Belgium
| | - An Vandebosch
- Division of Janssen Pharmaceutica NV; Janssen Research & Development; Beerse Belgium
| | | | - Marielle Eerdekens
- Division of Janssen Pharmaceutica NV; Janssen Research & Development; Beerse Belgium
| | - Virginie Herben
- Division of Janssen Pharmaceutica NV; Janssen Research & Development; Beerse Belgium
| | - Marc De Meulder
- Division of Janssen Pharmaceutica NV; Janssen Research & Development; Beerse Belgium
| | - Bart Remmerie
- Division of Janssen Pharmaceutica NV; Janssen Research & Development; Beerse Belgium
| | - Igor Francetic
- Institute of Clinical Pharmacology; Clinical Hospital Centre; Zagreb Croatia
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Cleton A, Rossenu S, Crauwels H, Berwaerts J, Hough D, Gopal S, Eerdekens M, Vandebosch A, Remmerie B, De Meulder M, Rosso CM. A single-dose, open-label, parallel, randomized, dose-proportionality study of paliperidone after intramuscular injections of paliperidone palmitate in the deltoid or gluteal muscle in patients with schizophrenia. J Clin Pharmacol 2014; 54:1048-57. [PMID: 24676998 DOI: 10.1002/jcph.295] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 02/24/2014] [Accepted: 03/24/2014] [Indexed: 11/05/2022]
Abstract
Paliperidone palmitate (PP) is a long-acting injectable (LAI) antipsychotic, developed for monthly intramuscular (i.m.) administration into deltoid/gluteal muscle, approved for the treatment of schizophrenia in many countries. To assess the options for i.m. injection sites, dose-proportionality of PP was investigated after injection of a single dose (25-150 mg eq.) of PP in either gluteal (n = 106) or deltoid (n = 95) muscle of schizophrenic patients. Overall, mean (geometric) area under plasma concentration-time curve from time zero to infinity (AUC∞ ) of paliperidone increased proportionally with increasing PP doses, regardless of injection site. Mean maximum plasma concentration (Cmax ) was slightly less than dose-proportional for both injection sites at PP doses >50 mg eq. Mean Cmax was higher after injection in the deltoid compared with the gluteal muscle, except for the 100 mg eq. dose, while AUC∞ for both injection sites was comparable at all doses. Median time to reach Cmax (tmax ) ranged from 13-14 days after deltoid and 13-17 days after gluteal injection across all doses. Single PP injections in deltoid and gluteal muscles in the dose range of 25-150 mg eq. were generally tolerable both locally and systemically.
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Affiliation(s)
- Adriaan Cleton
- Janssen Research & Development, Division of Janssen Pharmaceutica NV, Beerse, Belgium
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Crauwels H, van Heeswijk RPG, Stevens M, Buelens A, Vanveggel S, Boven K, Hoetelmans R. Clinical perspective on drug-drug interactions with the non-nucleoside reverse transcriptase inhibitor rilpivirine. AIDS Rev 2013; 15:87-101. [PMID: 23681436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Rilpivirine (TMC278) is a non-nucleoside reverse transcriptase inhibitor approved in combination with other antiretrovirals for the treatment of HIV-1 infection in treatment-naive adults (Edurant(®) 25 mg once daily; Complera(®) [USA]/Eviplera(®) [EU] once daily single-tablet regimen). Rilpivirine should be administered with a meal to optimize bioavailability. Its solubility is pH dependent. Rilpivirine is primarily excreted via the feces with negligible renal elimination. Rilpivirine is predominantly metabolized by cytochrome P450 3A4. There is no clinically relevant effect of age, gender, bodyweight, race, estimated glomerular filtration rate, or hepatitis B/C coinfection status on rilpivirine pharmacokinetics in adults. Drug-drug interactions were investigated with cytochrome P450 3A substrates, inducers and inhibitors, drugs altering intragastric pH, antiretrovirals, and other often coadministered drugs. Rilpivirine 25 mg once daily does not have a clinically relevant effect on exposure of coadministered drugs. Coadministration with cytochrome P450 3A inhibitors (ketoconazole, ritonavir-boosted protease inhibitors, telaprevir) results in increased rilpivirine plasma concentrations, but these are not considered clinically relevant; no dose adjustments are required. Coadministration of rilpivirine with cytochrome P450 3A inducers (e.g. rifampin, rifabutin) or compounds increasing gastric pH (e.g. omeprazole, famotidine) results in decreased rilpivirine plasma concentrations, which may increase the risk of virologic failure and resistance development. Therefore, strong cytochrome P450 3A inducers and proton-pump inhibitors are contraindicated. Histamine-2 receptor antagonists and antacids can be coadministered with rilpivirine, provided doses are temporally separated. No dose adjustments are required when rilpivirine is coadministered with: acetaminophen, phosphodiesterase type 5 inhibitors (sildenafil, etc.), atorvastatin (and other statins), oral contraceptives (ethinyl estradiol, norethindrone), chlorzoxazone (cytochrome P450 2E1 substrate), methadone, digoxin, tenofovir disoproxil fumarate, didanosine and other nuceos(t)ide reverse transcriptase inhibitors, and HIV integrase inhibitors (raltegravir, dolutegravir, GSK1265744).
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Affiliation(s)
- Herta Crauwels
- Clinical Pharmacology, Janssen Infectious Diseases BVBA, Beerse, Belgium.
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Hodder S, Arasteh K, De Wet J, Gathe J, Gold J, Kumar P, Mohapi L, Short W, Crauwels H, Vanveggel S, Boven K. Effect of gender and race on the week 48 findings in treatment-naïve, HIV-1-infected patients enrolled in the randomized, phase III trials ECHO and THRIVE. HIV Med 2012; 13:406-15. [PMID: 22416849 DOI: 10.1111/j.1468-1293.2012.00991.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVES A week 48 efficacy and safety analysis with respect to gender and race was conducted using pooled data from the phase III, double-blind, double-dummy efficacy comparison in treatment-naïve, HIV-infected subjects of TMC278 and efavirenz (ECHO) and TMC278 against HIV, in a once-daily regimen versus efavirenz (THRIVE) trials. METHODS Treatment-naïve, HIV-1-infected adults were randomized to receive rilpivirine (RPV; TMC278) 25 mg once a day (qd), or efavirenz (EFV) 600 mg qd, plus tenofovir/emtricitabine (ECHO) or tenofovir/emtricitabine, zidovudine/lamivudine or abacavir/lamivudine (THRIVE). RESULTS A total of 1368 participants (76% male and 61% White, of those with available race data) were randomized and treated. No gender-related differences in response rate (percentage of patients with HIV-1 viral load < 50 HIV-1 RNA copies/mL, using an intent-to-treat, time-to-loss-of-virological-response algorithm) were observed (RPV: men, 85%; women, 83%; EFV: men, 82%; women, 83%). Response rates were lower in Black compared with Asian and White participants (RPV: 75% vs. 95% and 85%, respectively; EFV: 74% vs. 93% and 83%, respectively); this finding was mostly a result of higher discontinuation and virological failure rates in Black patients. Safety findings were generally similar across race and gender subgroups. However, nausea occurred more commonly in women than in men in both treatment groups. In men, diarrhoea was more frequent in the EFV group, and abnormal dreams/nightmares were more frequent in men in both the EFV and RPV groups. CONCLUSIONS Overall response rates were high for both RPV and EFV. No gender differences were observed. However, response rates were lower among Black patients, regardless of treatment group. Gender appeared to influence the incidence of gastrointestinal adverse events and abnormal dreams/nightmares for both treatments.
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Affiliation(s)
- S Hodder
- UMDNJ-New Jersey Medical School, Newark, NJ 07103, USA
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Molina JM, Cahn P, Grinsztejn B, Lazzarin A, Mills A, Saag M, Supparatpinyo K, Walmsley S, Crauwels H, Rimsky LT, Vanveggel S, Boven K. Rilpivirine versus efavirenz with tenofovir and emtricitabine in treatment-naive adults infected with HIV-1 (ECHO): a phase 3 randomised double-blind active-controlled trial. Lancet 2011; 378:238-46. [PMID: 21763936 DOI: 10.1016/s0140-6736(11)60936-7] [Citation(s) in RCA: 318] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Efavirenz with tenofovir-disoproxil-fumarate and emtricitabine is a preferred antiretroviral regimen for treatment-naive patients infected with HIV-1. Rilpivirine, a new non-nucleoside reverse transcriptase inhibitor, has shown similar antiviral efficacy to efavirenz in a phase 2b trial with two nucleoside/nucleotide reverse transcriptase inhibitors. We aimed to assess the efficacy, safety, and tolerability of rilpivirine versus efavirenz, each combined with tenofovir-disoproxil-fumarate and emtricitabine. METHODS We did a phase 3, randomised, double-blind, double-dummy, active-controlled trial, in patients infected with HIV-1 who were treatment-naive. The patients were aged 18 years or older with a plasma viral load at screening of 5000 copies per mL or greater, and viral sensitivity to all study drugs. Our trial was done at 112 sites across 21 countries. Patients were randomly assigned by a computer-generated interactive web response system to receive either once-daily 25 mg rilpivirine or once-daily 600 mg efavirenz, each with tenofovir-disoproxil-fumarate and emtricitabine. Our primary objective was to show non-inferiority (12% margin) of rilpivirine to efavirenz in terms of the percentage of patients with confirmed response (viral load <50 copies per mL intention-to-treat time-to-loss-of-virological-response [ITT-TLOVR] algorithm) at week 48. Our primary analysis was by intention-to-treat. We also used logistic regression to adjust for baseline viral load. This trial is registered with ClinicalTrials.gov, number NCT00540449. FINDINGS 346 patients were randomly assigned to receive rilpivirine and 344 to receive efavirenz and received at least one dose of study drug, with 287 (83%) and 285 (83%) in the respective groups having a confirmed response at week 48. The point estimate from a logistic regression model for the percentage difference in response was -0.4 (95% CI -5.9 to 5.2), confirming non-inferiority with a 12% margin (primary endpoint). The incidence of virological failures was 13% (rilpivirine) versus 6% (efavirenz; 11%vs 4% by ITT-TLOVR). Grade 2-4 adverse events (55 [16%] on rilpivirine vs 108 [31%] on efavirenz, p<0.0001), discontinuations due to adverse events (eight [2%] on rilpivirine vs 27 [8%] on efavirenz), rash, dizziness, and abnormal dreams or nightmares were more common with efavirenz. Increases in plasma lipids were significantly lower with rilpivirine. INTERPRETATION Rilpivirine showed non-inferior efficacy compared with efavirenz, with a higher virological-failure rate, but a more favourable safety and tolerability profile. FUNDING Tibotec.
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Affiliation(s)
- Jean-Michel Molina
- Department of Infectious Diseases, Saint-Louis Hospital and University of Paris Diderot, Paris, France.
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Cohen CJ, Andrade-Villanueva J, Clotet B, Fourie J, Johnson MA, Ruxrungtham K, Wu H, Zorrilla C, Crauwels H, Rimsky LT, Vanveggel S, Boven K. Rilpivirine versus efavirenz with two background nucleoside or nucleotide reverse transcriptase inhibitors in treatment-naive adults infected with HIV-1 (THRIVE): a phase 3, randomised, non-inferiority trial. Lancet 2011; 378:229-37. [PMID: 21763935 DOI: 10.1016/s0140-6736(11)60983-5] [Citation(s) in RCA: 288] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The non-nucleoside reverse transcriptase inhibitor (NNRTI), rilpivirine (TMC278; Tibotec Pharmaceuticals, County Cork, Ireland), had equivalent sustained efficacy to efavirenz in a phase 2b trial in treatment-naive patients infected with HIV-1, but fewer adverse events. We aimed to assess non-inferiority of rilpivirine to efavirenz in a phase 3 trial with common background nucleoside or nucleotide reverse transcriptase inhibitors (N[t]RTIs). METHODS We undertook a 96-week, phase 3, randomised, double-blind, double-dummy, non-inferiority trial in 98 hospitals or medical centres in 21 countries. We enrolled adults (≥18 years) not previously given antiretroviral therapy and with a screening plasma viral load of 5000 copies per mL or more and viral sensitivity to background N(t)RTIs. We randomly allocated patients (1:1) using a computer-generated interactive web-response system to receive oral rilpivirine 25 mg once daily or efavirenz 600 mg once daily; all patients received an investigator-selected regimen of background N(t)RTIs (tenofovir-disoproxil-fumarate plus emtricitabine, zidovudine plus lamivudine, or abacavir plus lamivudine). The primary outcome was non-inferiority (12% margin on logistic regression analysis) at 48 weeks in terms of confirmed response (viral load <50 copies per mL, defined by the intent-to-treat time to loss of virologic response [TLOVR] algorithm) in all patients who received at least one dose of study drug. This study is registered with ClinicalTrials.gov, number NCT00543725. FINDINGS From May 22, 2008, we screened 947 patients and enrolled 340 to each group. 86% of patients (291 of 340) who received at least one dose of rilpivirine responded, compared with 82% of patients (276 of 338) who received at least one dose of efavirenz (difference 3.5% [95% CI -1.7 to 8.8]; p(non-inferiority)<0.0001). Increases in CD4 cell counts were much the same between groups. 7% of patients (24 of 340) receiving rilpivirine had a virological failure compared with 5% of patients (18 of 338) receiving efavirenz. 4% of patients (15) in the rilpivirine group and 7% (25) in the efavirenz group discontinued treatment due to adverse events. Grade 2-4 treatment-related adverse events were less common with rilpivirine (16% [54 patients]) than they were with efavirenz (31% [104]; p<0.0001), as were rash and dizziness (p<0.0001 for both) and increases in lipid levels were significantly lower with rilpivirine than they were with efavirenz (p<0.0001). INTERPRETATION Despite a slightly increased incidence of virological failures, a favourable safety profile and non-inferior efficacy compared with efavirenz means that rilpivirine could be a new treatment option for treatment-naive patients infected with HIV-1. FUNDING Tibotec.
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Affiliation(s)
- Calvin J Cohen
- Community Research Initiative of New England, Boston, MA 02215, USA.
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Crauwels H, Vingerhoets J, Ryan R, Witek J, Anderson D. Pharmacokinetic parameters of once-daily rilpivirine following administration of efavirenz in healthy subjects. Antivir Ther 2011; 17:439-46. [DOI: 10.3851/imp1959] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2011] [Indexed: 10/15/2022]
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