PK of Efavirenz & Lopinavir Nano-formulations in Healthy Volunteers

St Stephens Aids Trust

Status and phase: Suspended; Phase 1

Conditions: HIV

Treatments: Drug: 600mg Sustiva; Drug: 200mg NANO-Lopinavir; Drug: 400mg Sustiva; Drug: 400mg NANO-Lopinavir; Drug: Kaletra® (lopinavir 400mg/ritonavir 100mg); Drug: +/- 200mg ritonavir NORVIR; Drug: 300mg NANO-Efavirenz; Drug: 50mg NANO-efavirenz; Drug: 100mg Ritonavir; Drug: +/- 200mg NANO-Lopinavir; Drug: 200mg NANO-Efavirenz

Study type: Interventional

Funder types: Other

Identifiers

NCT02631473

SSAT 055

Details and patient eligibility

About

This study is an open-label, prospective pharmacokinetic study investigating two antiretroviral agents in parallel and employing an adaptive design with two stages, whereby the results obtained in the primary stage inform the doses selected for investigation in the secondary stage

Full description

The objectives of this study are:

Primary

• To investigate the pharmacokinetics of a new pharmaceutical formulation of efavirenz (NANO-efavirenz) in HIV negative healthy volunteers after single dose and a steady-state.
• To investigate the pharmacokinetics of a new pharmaceutical formulation of lopinavir (NANO-lopinavir) in HIV negative healthy volunteers

Secondary

• To investigate the safety and tolerability of NANO-efavirenz and NANO-lopinavir in HIV negative healthy volunteers
• To assess the bioequivalence of a selected single-dose of NANO-efavirenz to a single dose 600mg of efavirenz as Sustiva®
• To investigate the association between genetic polymorphisms in drug disposition genes and drug exposure

Enrollment: 50 estimated patients

Sex: All

Ages: 18 to 65 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

Volunteers must meet all of the following inclusion criteria within 28 days prior to the baseline visit:

1. The ability to understand and sign a written informed consent form, prior to participation in any screening procedures and must be willing to comply with all study requirements

2. Male or non-pregnant, non-lactating females

3. Between 18 to 65 years, inclusive

4. Body Mass Index (BMI) of 18 to 30 kg/m2, inclusive

5. Women of childbearing potential (WOCBP) must be using an adequate method of contraception to avoid pregnancy throughout the study and for a period of at least 12 weeks after the study

   A female may be eligible to enter and participate in the study if she:

   1. is of non-child-bearing potential defined as either post-menopausal (12 months of spontaneous amenorrhea and ≥ 45 years of age) or physically incapable of becoming pregnant with documented tubal ligation, hysterectomy or bilateral oophorectomy or,

   2. is of child-bearing potential with a negative pregnancy test at both Screening and Day 1 and agrees to use one of the following methods of contraception to avoid pregnancy:

      • Complete abstinence from penile-vaginal intercourse from 2 weeks prior to administration of IP, throughout the study, and for at least 2 weeks after discontinuation of all study medications;
      • Double barrier method (male condom/spermicide, male condom/diaphragm, diaphragm/spermicide);
      • Any intrauterine device (IUD) with published data showing that the expected failure rate is <1% per year (not all IUDs meet this criterion, see protocol appendix 7 for an example listing of approved IUDs);
      • Condom and depot medroxyprogesterone acetate ( DMPA) injections
      • Male partner sterilization confirmed prior to the female subject's entry into the study, and this male is the sole partner for that subject;
      • Any other method with published data showing that the expected failure rate is <1% per year.
      • Any contraception method must be used consistently, in accordance with the approved product label and for at least 2 weeks after discontinuation of IP.

6. Willing to consent to their personal details being entered onto the TOPS database

7. Willing to provide proof of identity by photographic ID at screen and any subsequent visit

8. Registered with a GP in the UK

Exclusion criteria

Volunteers who meet any of the following exclusion criteria are not to be enrolled in this study.

1. Any significant acute or chronic medical illness including hypertension (BP persistently >140/90 mmHg) or hypotension (BP persistently <90/60 mmHg)
2. Prolongation of ECG intervals: PR > 200 msec or QTcF > 450 msec.
3. Evidence of organ dysfunction or any clinically significant deviation from normal in physical examination, vital signs, ECG or clinical laboratory determinations.
4. Liver transaminase (ALT or AST > 1.25 x the upper limit of the normal range)
5. Significant psychiatric history (including severe depression) or history of seizures.
6. Positive blood screen for either hepatitis B surface antigen or hepatitis C antibody
7. Positive blood screen for HIV-1 and/or 2 antibodies
8. Current or recent (within 3 months) gastrointestinal disease
9. Clinically relevant alcohol or drug use (positive urine drug screen) or history of alcohol or drug use considered by the Investigator to be sufficient to hinder adherence to treatment, follow-up procedures or evaluation of adverse events. Smoking is permitted, but tobacco intake should remain consistent throughout the study
10. Known cardiac disease history of any family history of sudden cardiac death.
11. Exposure to any investigational drug or placebo within 3 months of first dose of study drug
12. Use of any other drugs (unless approved by the Investigator), including over-the-counter medications and herbal preparations, within two weeks prior to first dose of study drug, unless approved/prescribed by the Principal Investigator as known not to interact with study drugs.
13. Females of childbearing potential without the use of effective non-hormonal birth control methods, or not willing to continue practising these birth control methods for at least 12 weeks after the end of the treatment period
14. Previous allergy to any of the constituents of the pharmaceuticals administered in this trial
15. Rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucosegalactose malabsorption

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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50 participants in 6 patient groups

1st Stage-Group A

Active Comparator group

Description:

1. Day 1: 50 mg NANO-efavirenz single dose 2. Days 4-21: 50 mg NANO-efavirenz OD (once daily)

Treatment:

Drug: 50mg NANO-efavirenz

1st Stage-Group B

Active Comparator group

Description:

1. Days 1-7: 400mg NANO-lopinavir BID (twice daily) 2. Days 8-21: Wash-out period 3. Days: 22-28: 200mg NANO-lopinavir BID plus 100mg Ritonavir (Norvir) BID

Treatment:

Drug: 100mg Ritonavir

Drug: 400mg NANO-Lopinavir

Drug: 200mg NANO-Lopinavir

2nd Stage-Group A-Group 1-Dose level 1

Active Comparator group

Description:

1. 21 Days: 300mg NANO-efavirenz OD 2. 4 weeks: Wash-out period 3. 21 days: 600mg Sustiva OD

Treatment:

Drug: 300mg NANO-Efavirenz

Drug: 600mg Sustiva

2nd Stage-Group A-Group 2-Dose level 2

Active Comparator group

Description:

1. 21 Days: 200mg NANO-efavirenz OD 2. 4 weeks: Wash-out period 3. 21 days: 400mg Sustiva OD

Treatment:

Drug: 200mg NANO-Efavirenz

Drug: 400mg Sustiva

2nd Stage-Group B-Arm 1

Active Comparator group

Description:

1. 7 days: Kaletra® (lopinavir400mg/ritonavir100mg) BD 2. 2 weeks: Wash-out period 3. 7 days: NANO-lopinavir (200mg +/- ritonavir®)

Treatment:

Drug: +/- 200mg ritonavir NORVIR

Drug: Kaletra® (lopinavir 400mg/ritonavir 100mg)

Drug: +/- 200mg NANO-Lopinavir

2nd Stage-Group B-Arm 2

Active Comparator group

Description:

1. 7 days: NANO-lopinavir (200mg +/- ritonavir Norvir) 2. 2 weeks: Wash-out period 3. 7 days: Kaletra® (lopinavir400mg/ritonavir100mg) BD

Treatment:

Drug: +/- 200mg ritonavir NORVIR

Drug: Kaletra® (lopinavir 400mg/ritonavir 100mg)

Drug: +/- 200mg NANO-Lopinavir