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The purpose of the study is to evaluate the safety of the TFV/LNG intravaginal ring (IVR), TFV-only IVR, and placebo IVR, evaluate pharmacokinetics (PK) of TFV and LNG, evaluate pharmacodynamic (PD) surrogates of contraceptive efficacy of LNG, and to evaluate acceptability of the IVRs.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| TFV IVR | Experimental | TFV IVR is an intravaginal ring 55.0 mm in diameter, consisting of single segment of polyurethane tubing with an outer diameter of 5.5 mm and filled with white TFV-containing paste. Used for one month, the IVR delivers 8-10 mg/day TFV. |
|
| TFV/LNG IVR | Experimental | TFV/LNG IVR is an intravaginal ring 55.0 mm in diameter, consisting of two segments of polyurethane tubing with an outer diameter of 5.5 mm: a longer segment containing white TFV paste and a shorter one (20 mm) with a white LNG core. Used for one month, the IVR delivers 8-10 mg/day TFV and 20 μg/day LNG. |
|
| Placebo Intravaginal Ring | Placebo Comparator | Intravaginal ring 55.0 mm in diameter, consisting of two segments of polyurethane tubing with an outer diameter of 5.5 mm containing no active experimental ingredients. Used for one month. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| TFV IVR | Drug |
|
| |
| Measure | Description | Time Frame |
|---|---|---|
| Number of treatment-emergent adverse events | Number of treatment-emergent adverse events | IVR Day 1, 2, ~8, ~16-18; 24 hours and 1-2 weeks post-IVR insertion and 1-2 weeks after IVR removal |
| Systemic laboratory tests | Changes in Systemic laboratory tests | Baseline and IVR Day ~16-18 |
| Cervicovaginal ulcerations, abrasions, edema, and other findings | Development of cervicovaginal ulcerations, abrasions, edema, and other findings as assessed by naked eye and colposcopic visualization of the cervicovaginal epithelium | Baseline, IVR Day 2, ~8 and ~16-18 |
| Soluble markers of innate mucosal immunity and inflammatory response in cervicovaginal lavage (CVL) fluid | Changes in soluble markers of innate mucosal immunity and inflammatory response in CVL fluid | Baseline and IVR Day ~16-18 |
| HIV-1 target immune cell phenotype and HIV-1 activation/proliferation marker in cervicovaginal tissue (biopsy) | Changes in HIV-1 target immune cell phenotype and HIV-1 activation/proliferation marker in cervicovaginal tissue (biopsy) | Baseline and IVR Day ~16-18 |
| Microflora (semi-quantitative vaginal culture and/or unculturable bacteria) | Changes microflora (semi-quantitative vaginal culture and/or unculturable bacteria) | Baseline and IVR Day ~16-18 |
| Vaginal pH |
| Measure | Description | Time Frame |
|---|---|---|
| TFV concentrations in plasma | TFV concentrations in plasma | Baseline; 1, 2, 4 and 8 hrs post-IVR insertion; IVR Day 2, ~8, ~16-18; 24 hours post-IVR removal |
| TFV concentrations in cervicovaginal fluid (aspirate and swab) |
| Measure | Description | Time Frame |
|---|---|---|
| Cervical mucus assessment and sperm migration on the Simplified Slide test | Surrogates of contraceptive efficacy - Cervical mucus assessment | IVR Day ~8 |
| Ovulation by P4 | Surrogates of contraceptive efficacy - Ovulation by P4 |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Jill Schwartz, MD | CONRAD | Study Chair |
| Chris Mauck, MD | CONRAD | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Eastern Virginia Medical School | Norfolk | Virginia | 23507 | United States | ||
| Profamilia |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 31107913 | Derived | Thurman AR, Schwartz JL, Ravel J, Gajer P, Marzinke MA, Yousefieh N, Anderson SM, Doncel GF. Vaginal microbiota and mucosal pharmacokinetics of tenofovir in healthy women using tenofovir and tenofovir/levonorgestrel vaginal rings. PLoS One. 2019 May 20;14(5):e0217229. doi: 10.1371/journal.pone.0217229. eCollection 2019. | |
| 29953547 |
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| TFV/LNG IVR |
| Drug |
|
|
| Placebo IVR | Other |
|
|
Changes in vaginal pH
| Baseline and IVR Day ~16-18 |
| Nugent Score | Changes in Nugent Score | Baseline and IVR Day ~16-18 |
TFV concentrations in cervicovaginal fluid (aspirate and swab)
| 1, 2, 4 or 8 hours post-IVR insertion (randomized time point); IVR Day 2, ~8, ~16-18; 24 hours post-IVR removal |
| TFV concentrations in genital tissue (biopsy) | TFV concentrations in genital tissue (biopsy) | IVR Day 2, ~16-18; 24 or 72 hours post-IVR removal (randomized time point) |
| Tenofovir diphosphate (TFV-DP) concentrations in peripheral blood mononuclear cells (PBMCs) | TFV-DP concentrations in PBMCs | IVR Day ~16-18 |
| TFV-DP concentrations in genital tissue (biopsy) | TFV-DP concentrations in genital tissue (biopsy) | IVR Day 2, ~16-18; 24 or 72 hours post-IVR removal (randomized time point) |
| LNG concentration in blood (including SHBG) | LNG concentration in blood (including SHBG) | Baseline; 1, 2, 4 and 8 hrs post-IVR insertion; IVR Day 2, ~8, ~16-18; 24 hours post-IVR removal |
| LNG concentration in vaginal secretions (swabs) | LNG concentration in vaginal secretions (swabs) | Baseline; IVR Day~8 |
| LNG concentration in cervical mucus | LNG concentration in cervical mucus | IVR Day ~8, ~16-18; 24 hours post-IVR removal |
| Weight of returned IVRs | Weight of returned IVRs | IVR Day ~16-18 (post-removal) |
| Amount of drug remaining in returned IVRs | Amount of drug remaining in returned IVRs | IVR Day ~16-18 (post-removal) |
| IVR Day ~16-18 |
| Follicular development by serum estradiol concentration | Surrogates of contraceptive efficacy - Follicular development by serum estradiol concentration | IVR Day ~8, ~16-18 |
| Acceptability of IVR | Acceptability of IVR as measured by a composite of the following factors: Discontinuations, Expulsions, Removals, Visible changes (such as discoloration) as documented on photographs of returned IVRs, Responses to key questions on acceptability questionnaire | IVR Day ~16-18 (post-removal) |
| Pharmacodynamics | Pharmacodynamics - Anti-herpes simplex virus (HSV)-2 and Anti-HIV-1 activities in the CVL. Anti-HIV and anti-HSV activity as a percent of anti-HIV and anti-HSV activity before exposure to test product | Baseline, IVR Day ~16-18 |
| Pharmacodynamics | TFV anti-HIV efficacy in cervicovaginal tissues. Comparison of cervicovaginal tissue permissiveness to ex vivo infection with HIV-1 BaL between the control cycle and treatment cycle. | Baseline, IVR Day ~16-18 |
| Pharmacodynamic surrogates of LNG in endometrium | Findings on endometrial biopsy: Histology, Markers of endometrial function | Baseline, IVR Day ~16-18 |
| Endometrial thickness | Endometrial thickness as assessed by transvaginal ultrasound | Baseline, IVR Day ~16-18 |
| Cervicovaginal epithelial histology and epithelial integrity in cervicovaginal tissue (biopsy) | Cervicovaginal epithelial histology (thickness and number of cell layers) and epithelial integrity, as measured immuno-histochemistry (IHC) of epithelial junction proteins in cervicovaginal tissue (biopsy) | Baseline, IVR Day ~16-18 |
| Markers of mucosal alteration and inflammation (e.g., expression of COX-2) in cervicovaginal and endometrial tissue | Markers of mucosal alteration and inflammation (e.g., expression of COX-2) in cervicovaginal and endometrial tissue | Baseline, IVR Day ~16-18 |
| Microbial growth on swabs obtained from returned IVRs and microbial levels in returned IVRs | Microbial growth on swabs obtained from returned IVRs and microbial levels in returned IVRs | IVR Day ~16-18 (post-removal) |
| Level of association of TFV levels between less-invasive swabs and the more invasive biopsies, and possibly between swabs and aspirates | Level of association of TFV levels between less-invasive swabs and the more invasive biopsies, and possibly between swabs and aspirates | IVR Day 2, ~16-18; 24 hours post-IVR removal |
| Characterization of returned IVRs for physicochemical properties and potential chemical and/or biological measures of adherence | Characterization of returned IVRs for physicochemical properties and potential chemical and/or biological measures of adherence | IVR Day ~16-18 (post-removal) |
| Santo Domingo |
| Dominican Republic |
| Dominican Republic |
| Thurman AR, Schwartz JL, Brache V, Clark MR, McCormick T, Chandra N, Marzinke MA, Stanczyk FZ, Dezzutti CS, Hillier SL, Herold BC, Fichorova R, Asin SN, Rollenhagen C, Weiner D, Kiser P, Doncel GF. Randomized, placebo controlled phase I trial of safety, pharmacokinetics, pharmacodynamics and acceptability of tenofovir and tenofovir plus levonorgestrel vaginal rings in women. PLoS One. 2018 Jun 28;13(6):e0199778. doi: 10.1371/journal.pone.0199778. eCollection 2018. |