Official Title

A Drug Interaction Study to Assess the Pharmacokinetics of Narlaprevir and Antiretroviral Drugs
  • Phase

    Phase 1
  • Study Type

    Interventional
  • Study Participants

    36
The study purpose is to evaluate the potential for a pharmacokinetic drug-drug interaction, safety and tolerability when Narlaprevir, Ritonavir (used as a metabolic inhibitor) and Tenofovir disoproxil fumarate (part 1) and Narlaprevir, Ritonavir and Raltegravir (part 2) are administered in combination to healthy volunteers.
The current study includes 2 parts, as the following drugs may be used concomitantly to treat hepatitis C virus (HCV)/HIV coinfection:

Part 1 of the study is being conducted to evaluate the pharmacokinetic effect of coadministration of narlaprevir with ritonavir and tenofovir disoproxil fumarate.
Part 2 of the study is being conducted to evaluate the pharmacokinetic effect of coadministration of narlaprevir/ritonavir and raltegravir.

Each part of the study is designed as a randomized 3-period crossover study and will assess if there is any effect of tenofovir disoproxil fumarate or raltegravir on the pharmacokinetics of narlaprevir and vice versa.

Subjects will be screened within 28 days before dosing in this multi-part study. All subjects eligible for protocol criteria will be randomized 1:1:1 to receive one of the following treatment sequences: A/B/C, or B/C/A, or C/A/B. Every subject will receive only one treatment (A or B or C) in one Period. Subjects will be confined to the study center throughout treatment in each period. Following completion of study procedures for each treatment period, subjects will be released from the clinic. After a 7-14 (maximum) days interval between dosing, subjects will return to start hospitalization for the next treatment period. Subjects will be discharged from the study upon completion of all study related procedures in Period 3. Phone call will be conducted after 5-7 days of follow-up period to assess safety data.

This drug interaction study is designed to investigate pharmacokinetic drug-drug interactions between Narlaprevir coadministered with Ritonavir and antiretroviral drugs (Tenofovir disoproxil fumarate and Raltegravir) for labeling and clinical dosing guidance purposes.
Study Started
Apr 24
2017
Primary Completion
Jun 24
2017
Study Completion
Jun 30
2017
Results Posted
Feb 19
2019
Last Update
Feb 19
2019

Drug Narlaprevir

100 mg, film-coated tablets, taken as 200 mg per os daily

  • Other names: Arlansa

Drug Ritonavir

100 mg, film-coated tablets, taken as 100 mg per os daily

  • Other names: Norvir

Drug Tenofovir Disoproxil Fumarate

300 mg, film-coated tablets, taken as 300 mg per os daily

  • Other names: Tenofovir-TL, Viread

Drug Raltegravir

400 mg, film-coated tablets, taken as 400 mg per os daily

  • Other names: Isentress

Treatment A (Part 1/ Part 2) Active Comparator

Narlaprevir 200 mg once daily with Ritonavir 100 mg once daily for 5 days

Treatment B (Part 1) Active Comparator

Tenofovir disoproxil fumarate 300 mg once daily for 5 days

Treatment B (Part 2) Active Comparator

Raltegravir 400 mg twice daily for 5 days

Treatment C (Part 1) Experimental

Narlaprevir 200 mg once daily coadministered with ritonavir 100 mg once daily and Tenofovir disoproxil fumarate 300 mg once daily for 5 days

Treatment C (Part 2) Experimental

Narlaprevir 200 mg once daily coadministered with ritonavir 100 mg once daily and 400 mg raltegravir twice daily for 5 days

Criteria

Inclusion Criteria (the subject must meet all the criteria listed below for entry at baseline and at Days -1 and 1 before each treatment Period):

Subjects must be willing to give written informed consent for the trial and able to adhere to dose and visit schedules.
Subjects having a Body Mass Index (BMI) between 18,5 and 30 kg/m^2, inclusive.
Subjects should diagnosed as "healthy": no pathology of the gastrointestinal tract, liver, kidneys, cardiovascular system, central nervous system (previously carried out by standard clinical and lab tests which did not reveal the presence of any diseases. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) must not exceed the normal range; QT interval calculated by Bazett's formula (QTcB) for men should be ≤ 450 ms and ≤ 470 ms for women, the interval PR should be ≤ 200 ms).

Vital sign measurements (taken after ~3 minutes in a supine or sitting position) must be within the following ranges:

systolic blood pressure, 100 - 130 mm Hg;
diastolic blood pressure, 60 -90 mm Hg;
pulse rate, 60-80 bpm.

Female subjects must be:

postmenopausal (defined as 12 months with no menses; age > 40 years and with a follicle-stimulating hormone (FSH) level of >40 u/mL);
surgically sterilized at least 3 months prior to baseline (e.g., documented hysterectomy or tubal ligation).
Men must agree to use a medically accepted method of contraception (condom and spermicide) during the trial and for 3 months after stopping the medication.

Exclusion Criteria (the subject will be excluded from entry if any of the criteria listed below are met at baseline):

Females with childbearing potential.
Subjects who, in the opinion of the investigator, will not be able to participate optimally in the study.
Positive results for hepatitis B surface antigen, hepatitis C antibodies or HIV, positive RW results.
Allergic reactions in history.
Intolerance to medication.
Chronic disease of cardiovascular, bronchopulmonary, and/or neuroendocrine systems, gastrointestinal, liver, pancreas, kidney and/or blood disease.
History or presence of impaired renal function, lactase deficiency, lactose intolerance, glucose-galactose malabsorption.
History of urinary obstruction or difficulty in voiding.
Gastrointestinal surgery in history (except of appendectomy).
Acute infections less than 4 weeks before participation in the study.
Subjects with a medical history of osteopenia and/or osteoporosis.
Regular administration of any medicines less than 4 weeks before participation in the study.
Administration of medicines with marked influence on hemodynamics, liver function et al (barbiturates, omeprazole, cimetidine et al) less than 30 days before participation in the study.
Blood donation (450 ml or more of blood or plasma) less than 2 months before participation in the study.
Intake of more than 10 units of alcohol in a week (1 unit of alcohol is equal to 0.5 L of beer, 200 mL of wine or 50 mL of spirits) or history of drug abuse or alcoholism.
Smoking of more than 10 cigarettes or equivalent tobacco use per day.
Participation in phase 1 clinical trial less than 3 months before participation in the study.
Positive screen for drugs abuse and drugs use.
Subjects with a medical history of psychiatric or personality disorders that in the opinion of the investigator and sponsor, affects the subject's ability to participate in the trial.
Subjects who are part of the study staff personnel or family members of the study staff personnel.

Summary

Treatment A (Part 1)

Treatment B (Part 1)

Treatment C (Part 1)

Treatment A (Part 2)

Treatment B (Part 2)

Treatment C (Part 2)

All Events

Event Type Organ System Event Term Treatment A (Part 1) Treatment B (Part 1) Treatment C (Part 1) Treatment A (Part 2) Treatment B (Part 2) Treatment C (Part 2)

Cmax of Narlaprevir

Maximum observed Concentration of Narlaprevir at Day 5 of treatment A and C of Part 1 or 2 of the study

Treatment A (Part 1)

2130.2742
ng/ml (Geometric Mean)
90% Confidence Interval: 1817.4088 to 2731.8348

Treatment C (Part 1)

2172.233
ng/ml (Geometric Mean)
90% Confidence Interval: 1895.673 to 2726.557

Treatment A (Part 2)

2946.131
ng/ml (Geometric Mean)
90% Confidence Interval: 2617.485 to 3799.642

Treatment C (Part 2)

2880.612
ng/ml (Geometric Mean)
90% Confidence Interval: 2412.858 to 4121.871

AUCtau of Narlaprevir

Area Under the Concentration-time curve during a dosing interval τ at steady state of Narlaprevir at Day 5 of treatment A and C of Part 1/ Part 2 of the study

Treatment A (Part 1)

20504.31
ng*h/ml (Geometric Mean)
90% Confidence Interval: 18265.63 to 24328.95

Treatment C (Part 1)

21366.2
ng*h/ml (Geometric Mean)
90% Confidence Interval: 18664.1 to 26481.9

Treatment A (Part 2)

26199.19
ng*h/ml (Geometric Mean)
90% Confidence Interval: 23136.15 to 33132.53

Treatment C (Part 2)

24458.48
ng*h/ml (Geometric Mean)
90% Confidence Interval: 20738.76 to 33597.42

Cmax of Tenofovir

Maximum observed Concentration of Tenofovir at Day 5 of treatment B and C of Part 1 of the study

Treatment B (Part 1)

263.037
ng/ml (Geometric Mean)
90% Confidence Interval: 233.126 to 313.318

Treatment C (Part 1)

344.796
ng/ml (Geometric Mean)
90% Confidence Interval: 302.457 to 415.092

AUCtau of Tenofovir

Area Under the Concentration-time curve during a dosing interval τ at steady state of Tenofovir at Day 5 of treatment B and C of Part 1 of the study

Treatment B (Part 1)

2599.95
ng*h/ml (Geometric Mean)
90% Confidence Interval: 2325.72 to 3043.02

Treatment C (Part 1)

2799.72
ng*h/ml (Geometric Mean)
90% Confidence Interval: 2536.67 to 3205.65

Cmax of Raltegravir

Maximum observed Concentration of Raltegravir at Day 5 of treatment B and C of Part 2 of the study

Treatment B (Part 2)

830.204
ng/ml (Geometric Mean)
90% Confidence Interval: 520.042 to 2758.109

Treatment C (Part 2)

715.726
ng/ml (Geometric Mean)
90% Confidence Interval: 136.163 to 2396.13

AUCtau of Raltegravir

Area Under the Concentration-time curve during a dosing interval τ at steady state of Tenofovir at Day 5 of treatment B and C of Part 2 of the study

Treatment B (Part 2)

2912.45
ng*h/ml (Geometric Mean)
90% Confidence Interval: 1983.01 to 8451.44

Treatment C (Part 2)

2653.65
ng*h/ml (Geometric Mean)
90% Confidence Interval: 1033.88 to 6964.58

Number of Patients With Adverse Events

Treatment A (Part 1)

Treatment B (Part 1)

Treatment C (Part 1)

Treatment A (Part 2)

Treatment B (Part 2)

Treatment C (Part 2)

Number of Patients With Changes in Vital Signs

There were no subjects with abnormal changes in vital signs

Treatment A (Part 1)

Treatment B (Part 1)

Treatment C (Part 1)

Treatment A (Part 2)

Treatment B (Part 2)

Treatment C (Part 2)

Number of Patients With Abnormal Laboratory Values

Treatment A (Part 1)

Part 1

Part 2

Treatment B (Part 1)

Part 1

Part 2

Treatment C (Part 1)

Part 1

Part 2

Number of Patients With Abnormal ECG Changes

There were no subjects with abnormal ECG changes during the study

Treatment A (Part 1/Part 2)

Part 1

Part 2

Treatment B (Part 1/Part 2)

Part 1

Part 2

Treatment C (Part 1/Part 2)

Part 1

Part 2

Total

36
Participants

Age, Continuous

Age, Continuous

Body Mass Index (BMI)

Body Mass Index (BMI)

Race/Ethnicity, Customized

Race/Ethnicity, Customized

Sex: Female, Male

Sex: Female, Male

First Intervention (A or B or C)

Part 1

Part 2

First Washout Period (8 Days)

Part 1

Part 2

Second Intervention (A or B or C)

Part 1

Part 2

Second Washout Period (8 Days)

Part 1

Part 2

Third Intervention (A or B or C)

Part 1

Part 2