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The study will be a randomized, open-label, cross-over clinical pharmacokinetic trial to investigate a strategy for probenecid "boosting" in the setting of tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) for HIV pre-exposure prophylaxis (PrEP). The study will be conducted at the Indiana University Clinical Research Center. All samples will be processed and the amount of tenofovir/FTC in plasma, blood, and urine, and tenofovir diphosphate and emtricitabine in peripheral blood mononuclear cells will be determined using validated analytical methods developed by the investigators at the University of Colorado. Probenecid plasma and urine concentrations will also be measured using an in-house assay. Following completion of the study, the secondary aim will be accomplished via analysis of selected samples collected at baseline and following treatment. Those selected samples will be assessed for urinary markers of proximal tubulopathy (urine total protein, albumin, creatinine, phosphorus, retinol binding protein, and beta-2-microglobulin) and serum alkaline phosphatase, osteocalcin, procollagen type 1 N propeptide, cystatin C, and creatinine to determine if the probenecid boosting strategy does indeed lead to less potential renal and bone toxicity.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control | Active Comparator | The control phase will consist of subjects taking 600/400 mg oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) on day 1 (2 tablets) followed by 300/200 mg (1 tablet) doses on days 2 and 3. |
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| Treatment | Experimental | The treatment phase will consist of subjects taking 600/400 mg oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) (2 tablets) along with a 2 gram oral probenecid (PRO) dose (4 tablets, 500 mg each) on day 1. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Probenecid Oral Tablet | Drug | Included in arm/group descriptions. |
| |
| Measure | Description | Time Frame |
|---|---|---|
| Plasma TFV AUC0-INF GMR | The geometric mean ratio (GMR) of the plasma TFV area under the curve (AUC) comparing the test phase (T) to control phase (C) was assessed. PK samples were collected from 0 to 72 hours post-dose. | The first 72 hours of each phase. |
| PBMC TFV-DP AUC GMR | The geometric mean ratio (GMR) of the PBMC TFV-DP area under the curve (AUC) comparing the test phase (T) to control phase (C) was assessed. PK samples were collected from 0 to 72 hours post-dose. | The first 72 hours of each phase. |
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Inclusion Criteria:
Exclusion Criteria:
1. Are underweight (weigh less than 52 kg or 114 lb) or overweight [body mass index (BMI) greater than 32].
2. Females will be excluded to reduce study variability for this first proof of concept study.
3. Have insufficient renal function (estimated Creatinine Clearance ≤ 90 mL/min).
4. Have history of current alcohol or drug abuse (more than 4 alcoholic drinks per day on a regular basis).
5. Have history of intolerance, allergic reactions (e.g. rash) or other forms of hypersensitivities to any of the study medications (tenofovir disoproxil fumarate/ emtricitabine, probenecid).
6. Have taken TDF or FTC as part of pre-exposure prophylaxis within the past 6 weeks.
7. Any current major illness or chronic illness such as (but not limited to) kidney disease, hepatic disease, diabetes mellitus, gout, hypertension, coronary artery disease, chronic obstructive pulmonary disease, cancer, chronic active hepatitis B virus (HBV) infection, or HIV.
8. History of anemia or any other significant hematologic disorder. 9. Have history or current gastrointestinal disorders such as persistent diarrhea or malabsorption that would interfere with the absorption of orally administered drugs.
10. Have a serious infection within the last week before study enrollment. 11. Have donated blood within the past two months. 12. Have blood results that do not fall in a healthy range (e.g., blood hemoglobin less than 12.0 mg/dl).
13. Are taking on regular basis substances that may interfere with the metabolism (breakdown) of study medications by the body, including prescription medications, over-the-counter, herbal or dietary supplements, alternative medications, or hormonal agents (i.e. oral contraceptives, intra-uterine device with hormones).
14. Have a life style that places subjects at a higher risk for contracting HIV during the study period (e.g. active illicit drug use, excessive alcohol drinking, sexually transmitted infection (including gonorrhea, chlamydia, syphilis, herpes, human papilloma virus) within the past one year, or having more than one sexual partner in the past 6 months).
15. Positive HIV antibody test. 16. Positive HBV surface antigen test. 17. Have participation in a research study or use of an investigational drug in the last one month.
18. Are employed or are student under supervision of any of the investigators of this study.
19. Cannot state a good understanding of this study including risks and requirements; are unable to follow the rules of this study.
20. Cannot commit the time requested for this study.
Only male healthy volunteers will be enrolled.
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| Name | Affiliation | Role |
|---|---|---|
| Brandon T Gufford, PharmD, PhD | Indiana Unversity School of Medicine | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Indiana University Clinical Research Center at University Hospital | Indianapolis | Indiana | 46202 | United States |
We do not plan to share IPD with other researchers.
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| ID | Title | Description |
|---|---|---|
| FG000 | Treatment TDF/FTC+PRO Dose First, Then Control TDF/FTC | Participants received the treatment phase of 600/400 mg oral TDF/FTC along with a 2 gram oral PRO on day 1, 2-week washout, then the control phase of 600/400 mg oral TDF/FTC on day 1 followed by 300/200 mg oral TDF/FTC on days 2 and 3. |
| FG001 | Control TDF/FTC First, Then Treatment TDF/FTC+PRO Dose | Participants received the control phase of 600/400 mg oral TDF/FTC on day 1 followed by 300/200 mg oral TDF/FTC on days 2 and 3, 2-week washout, then the treatment phase of 600/400 mg oral TDF/FTC along with a 2 gram oral PRO on day 1. |
| Title | Milestones | Reasons Not Completed | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
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| ID | Title | Description |
|---|---|---|
| BG000 | All Study Participants | All participants received control and/or treatment phase The control phase will consist of subjects taking 600/400 mg oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) on day 1 (2 tablets) followed by 300/200 mg (1 tablet) doses on days 2 and 3. The treatment phase will consist of subjects taking 600/400 mg oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) (2 tablets) along with a 2 gram oral probenecid (PRO) dose (4 tablets, 500 mg each) on day 1. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Plasma TFV AUC0-INF GMR | The geometric mean ratio (GMR) of the plasma TFV area under the curve (AUC) comparing the test phase (T) to control phase (C) was assessed. PK samples were collected from 0 to 72 hours post-dose. | Primary result was performed for geometric mean ratio of treatment phase to control phase. | Posted | Least Squares Mean | 90% Confidence Interval | ng*h/mL | The first 72 hours of each phase. |
|
Adverse events were collected over 1 year during study conduction.
All adverse events reported from participant were included and graded for severity by the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE). Adverse events were reviewed per patient by treatment and was not separated individually.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Control Phase | The control phase consisted of subjects taking 600/400 mg oral TDF/FTC on day 1 followed by 300/200 mg TDF/FTC on days 2 and 3. |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Nausea, vomiting, or GERD | Gastrointestinal disorders | Systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Zeruesenay Desta | Division of Clinical Pharmacology, School of Medicine, Indiana University | 317-274-2823 | zdesta@iu.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Jul 5, 2017 | Mar 14, 2018 | Prot_SAP_000.pdf |
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| ID | Term |
|---|---|
| D011339 | Probenecid |
| D000068698 | Tenofovir |
| D000068679 | Emtricitabine |
| D000069480 | Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination |
| ID | Term |
|---|---|
| D013449 | Sulfonamides |
| D000577 | Amides |
| D009930 | Organic Chemicals |
| D013450 | Sulfones |
| D013457 |
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Subjects will be randomly allocated to enter the study in either the control or treatment arm using a blocked design to ensure equal numbers of subjects in each sequence group (n=8, control to treatment; n=8, treatment to control). Following a washout period of at least 6 weeks, each individual will crossover to the next study phase. The randomization table will be constructed prior to subject enrollment by the Principal Investigator using the Statistical Analysis Software (SAS®) randomization procedure. In the event that an individual is withdrawn from the study, an alternate participant will replace that individual using an identical study sequence to maintain the block design. A total of 16 subjects will be initially enrolled in an effort to ensure that at least 14 subjects complete the entire study. If needed, additional subjects will be screened and enrolled until the target enrollment of n=14 subjects have completed the entire study.
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This will be an open-label study.
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| Tenofovir disoproxil fumarate/Emtricitabine |
| Drug |
Included in arm/group descriptions. |
|
|
| Participants |
|
| Age, Continuous | Median | Full Range | years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Race (NIH/OMB) | Count of Participants | Participants |
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| Region of Enrollment | Count of Participants | Participants |
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| Primary | PBMC TFV-DP AUC GMR | The geometric mean ratio (GMR) of the PBMC TFV-DP area under the curve (AUC) comparing the test phase (T) to control phase (C) was assessed. PK samples were collected from 0 to 72 hours post-dose. | Posted | Least Squares Mean | 90% Confidence Interval | fmol*h/10^6cells | The first 72 hours of each phase. |
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| 0 |
| 14 |
| 0 |
| 14 |
| 2 |
| 14 |
| EG001 | Treatment Phase | The treatment phase consisted of subjects taking 600/400 mg oral TDF/FTC followed by 2 gram oral PRO on day 1. | 0 | 15 | 0 | 15 | 8 | 15 |
| Headache or loss of appetite | Nervous system disorders | Systematic Assessment |
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| Nose bleed | Blood and lymphatic system disorders | Systematic Assessment |
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| Sulfur Compounds |
| D063065 | Organophosphonates |
| D009943 | Organophosphorus Compounds |
| D000225 | Adenine |
| D011687 | Purines |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D006571 | Heterocyclic Compounds |
| D003841 | Deoxycytidine |
| D003562 | Cytidine |
| D011741 | Pyrimidine Nucleosides |
| D011743 | Pyrimidines |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D003853 | Deoxyribonucleosides |
| D009705 | Nucleosides |
| D009706 | Nucleic Acids, Nucleotides, and Nucleosides |
| D004338 | Drug Combinations |
| D004364 | Pharmaceutical Preparations |