Pharmacokinetics and Safety of Double-dose Dolutegravir When Used With Rifapentine for HIV-associated Tuberculosis

National Institute of Allergy and Infectious Diseases (NIAID)

Status and phase: Active, not recruiting; Phase 2

Conditions: HIV-associated Tuberculosis

Treatments: Drug: DTG 50 mg orally QD plus TDF/3TC; Drug: 2HPM; Drug: 2HPZM; Drug: Dolutegravir (DTG) 50 mg orally BID (~12 hours apart) plus TDF/3TC

Study type: Interventional

Funder types: Industry; NIH

Identifiers

NCT05630872

A5406

Details and patient eligibility

About

A5406 hypothesizes that dolutegravir (DTG) 50 mg taken twice daily will provide adequate exposures to maintain viral suppression when dosed with rifapentine (RPT) 1200 mg for HIV-associated TB.

Full description

This is an open-label, single arm, phase II, multicenter PK study to investigate the effect of daily RPT 1200 mg on DTG exposure in participants with HIV-associated TB. Adults with HIV with newly diagnosed DS-TB who are not currently on ART will be recruited around the time of DS TB diagnosis. At study entry, the 2HPZM/2HPM regimen will be initiated for anti-tuberculosis (anti-TB) therapy and continued for 17 weeks.

Enrollment: 30 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. Individuals ≥18 years of age at study entry.

2. Weight ≥40 kg.

3. Body mass index (BMI) >18.5 kg/m2.

4. Ability and willingness of participant or legal guardian/representative to provide informed consent.

5. Documentation of HIV-1 status.

6. CD4+ cell count ≥100 cells/mm3 obtained within 30 days prior to study entry at any network-approved non-US laboratory that is IQA certified.

7. ART-naïve or not on ART for 12 consecutive weeks prior to TB diagnosis.

8. Willingness and eligibility to start DTG-based ART at 6 weeks, with a window of ±1 week, after starting TB treatment, with no intention to change ART for the duration of the study.

9. Documentation of pulmonary TB.

10. Willingness to start 2HPZM/2HPM therapy for DS-TB.

11. The following laboratory values obtained within 30 days prior to study entry:

    • Absolute neutrophil count (ANC) >750 cells/mm3
    • Hemoglobin ≥7.4 g/dL
    • Platelet count ≥50,000/mm3
    • Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT]) <2.5 X the upper limit of normal (ULN)
    • Alanine aminotransferase (ALT) (serum glutamic pyruvic transaminase [SGPT]) <2.5 x ULN
    • Total bilirubin ≤1.5 x ULN
    • Creatinine <1.3 x ULN

12. For participants who can become pregnant, negative serum or urine pregnancy test at screening within 30 days prior to entry and within 48 hours prior to entry.

13. Participants who can become pregnant must agree not to participate in the conception process and if participating in sexual activity that could lead to pregnancy, must agree to use one reliable nonhormonal method of contraception.

14. Documentation of Karnofsky performance score ≥50 within 30 days prior to entry.

Exclusion criteria

1. Breastfeeding, pregnant, or plans to become pregnant.
2. Known allergy/sensitivity or any hypersensitivity to components of the study drugs, or their formulations.
3. Active drug or alcohol use or dependence that, in the opinion of the site investigator, would interfere with adherence to study requirements.
4. Requirement for ongoing use of drugs that are known to have significant drug-drug interactions with DTG or RPT.
5. Known history of acute intermittent porphyria.
6. Previous treatment for active TB disease.
7. More than 5 days of treatment directed against active TB for the current TB episode preceding study entry.
8. At the time of study entry, documentation of an M. tuberculosis isolate from the current or previous treatment episode known to be resistant to RIF or INH.
9. Known history of prolonged QT syndrome.
10. Known cirrhosis, a history of decompensated liver disease (ascites, hepatic encephalopathy, or esophageal varices).
11. Documentation of severe opportunistic infections, in the opinion of the site investigator, within 3 months of study entry.
12. Documentation of severe extra-pulmonary TB (e.g., meningitis, osteomyelitis, disseminated TB) at the time of screening.
13. Acute gout at the time of screening.

Trial design

Primary purpose: Treatment

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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30 participants in 1 patient group

Adults with HIV and newly diagnosed DS-TB not currently on ART

Experimental group

Description:

Participants will receive daily rifapentine-moxifloxacin plus isoniazid and pyrazinamide for 8 weeks followed by daily rifapentine-moxifloxacin plus isoniazid for 9 weeks (referred to as 2HPZM/2HPM) for anti-tuberculosis (anti-TB) therapy at study entry. DTG-based ART at 50 mg twice daily (BID) will be started after 6 weeks of TB therapy and will be continued for 2 weeks after completion of TB therapy. Two weeks after completion of TB therapy DTG will be reduced to standard dose 50 mg once daily (QD).

Treatment:

Drug: Dolutegravir (DTG) 50 mg orally BID (~12 hours apart) plus TDF/3TC

Drug: 2HPZM

Drug: 2HPM

Drug: DTG 50 mg orally QD plus TDF/3TC