An Interaction Study to Assess Drug Levels in Healthy Adult Subjects

Study Overview
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Brief Summary
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To date, no study has investigated whether there is a drug interaction between the protease inhibitor fosamprenavir and the entry inhibitor maraviroc. COL112237 is a randomized, open-label, 6-arm, 3-period, drug interaction study to assess steady-state plasma amprenavir (APV) and maraviroc (MVC) pharmacokinetics in 48 healthy, HIV-negative adults after administration of a 7-day regimen of MVC 300mg BID alone and after 14-day regimens of unboosted fosamprenavir (FPV) 1400mg twice daily (BID), FPV 700mg/RTV 100mg BID, or FPV 1400mg/ritonavir (RTV) 100mg once daily (QD) with and without concurrent MVC 300mg BID. Blood samples for drug concentration measurement will be collected over 12 hours at the end of each dosing period. Subjects will undergo a physical examination, complete blood count (CBC) with differential, HIV test, hepatitis B/C test, liver function test, renal function analysis, and lipid panel at screening, and all of these tests, except those for HIV and hepatitis B/C, will be repeated at follow-up post-study. Adverse events and adherence (by pill count and medication diary) will be assessed by the investigator/study personnel at the end of each dosing period.

Detailed Description
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This randomized, open-label, six-arm, three-period drug interaction study will recruit 48 healthy volunteers so as to obtain a minimum of 36 evaluable subjects at a single study center in the U.S. The study will have a screening visit, 3 treatment visits for PK sampling and a follow-up visit. The screening visit will be conducted within 30 days prior to receiving the first dose. Subjects will then be randomized into 1 of 6 treatment groups as shown below: Cohort Size Period 1 Days 1 to 7 Period 2 Days 1-14 Period 3 Days 1-14 A 8 MVC 300mg BID; FPV 1400mg BID; FPV 1400mg BID & MVC 300mg BID B 8 MVC 300mg BID; FPV 1400mg BID & MVC 300mg BID; FPV 1400mg BID C 8 MVC 300mg BID; FPV 700mg BID & RTV 100mg BID; FPV 700mg BID & RTV 100mg BID &MVC 300mg BID D 8 MVC 300mg BID; FPV 700mg BID & RTV 100mg BID & MVC 300mg BID; FPV 700mg BID & RTV 100mg BID E 8 MVC 300mg BID; FPV 1400mg QD & RTV 100mg QD; FPV 1400mg QD & RTV 100mg QD & MVC 300mg BID F 8 MVC 300mg BID; FPV 1400mg QD & RTV 100mg QD & MVC 300mg BID; FPV 1400mg QD & RTV 100mg QD Study subjects will enter the clinic in the morning prior to dosing and remain at the center for 12 hours following each dose. Fourteen to 21 days following completion of the third dosing period, study subjects will return to the clinic for follow-up assessment. The total duration of the study will be approximately 86 days from screening through follow up. Blood samples for drug concentration measurement of amprenavir (APV) and maraviroc(MVC) concentrations will be collected over 12 hours at the end of each dosing period (at 0 [baseline], 0.5, 1, 1.5, 2, 3, 4, 6, 8, and 12 hours post-dose). Subjects will undergo a physical examination, CBC with differential, HIV test, hepatitis B/C test, liver function test, renal function analysis, and lipid panel at screening, and all of these tests except those for HIV and hepatitis B/C will be repeated at follow-up post-study. Adverse events and adherence (by pill count and medication diary) will be assessed by the investigator/study personnel at the end of each dosing period. Evaluable patients will be required to have adhered to at least 95% of their study drug doses. Plasma APV and MVC concentrations will be analyzed using a validated high-performance liquid chromatography method with tandem mass spectrometric detection (HPLC/MS/MS). Plasma APV and MVC pharmacokinetic parameters measured will include maximum concentration (Cmax), time to maximum concentration (Tmax), minimum concentration (Cmin), and area under the concentration-time curve (AUC). All these parameters, except Tmax, will be log-transformed before statistical analysis. Analysis of variance, considering treatment as a fixed effect and subject as a random effect will be performed using Statistical Analysis Software (SAS), and assuming a treatment ratio for steady-state APV PK parameters as 1.0, the 90% confidence intervals will be within the range 0.81-1.24.

Official Title
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Steady State Pharmacokinetics (PK) of Fosamprenavir (FPV) Alone or in Combination With Low Dose Ritonavir (/r) (1400mg BID, 1400mg/100mg QD or 700/100mg BID) and the Chemokine Receptor 5 (CCR5) Entry Inhibitor Maraviroc (MVC) 300mg BID in Healthy Volunteers

Conditions
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Healthy

Intervention / Treatment
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* Drug: Maraviroc
* Drug: Fosamprenavir
* Drug: Ritonavir


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Healthy subjects with no clinically significant abnormality identified by physician by evaluation of medical history, physical examination, clinical laboratory tests or vital signs. between 18 and 64 years, A female subject is eligible to participate if she is neither pregnant nor lactating, and falls into one of the following categories: non-childbearing potential including females with documented (medical report verification) hysterectomy or bilateral oophorectomy, or post-menopausal females defined as being amenorrheic for greater than 1 year and having estradiol and follicle stimulating hormone (FSH) levels consistent with menopause. child-bearing potential with a negative serum pregnancy test at screen and who agrees to use one of the following methods of contraception from screening or at least two weeks prior to the first dose (whichever is earlier) until the follow-up visit (any contraception method must be used consistently and correctly, i.e., in accordance with both the product label and the instructions of a physician). Agreement for complete abstinence from intercourse Double barrier contraception (male condom/spermicide, male condom/diaphragm, diaphragm/spermicide) Any intrauterine device (IUD) with published data showing that the expected failure rate is less than 1% per year (not all IUDs meet this criterion) Any other method with published data showing that the lowest expected failure rate for that method is less than 1% per year. Adequate renal function (calculated creatinine clearance via Cockcroft and Gault method (CrCl) > 50 mL/min); Adequate hepatic function (total bilirubin < 2.5mg/dL; hepatic transaminases < 5x normal); Adequate hematologic function (absolute neutrophil count [ANC] > 750 neutrophils/mm^3; platelets > 50,000/mm^3; hematocrit > 25%); Non-smoker, defined as not having used nicotine-containing products within the past 6 months. Willingness and ability to adhere to treatment and follow-up procedures; The ability to understand and sign a written informed consent form. Body weight > or =50 kg for males and > or=45 kg for females and body mass index (BMI) in the range of 19 to 30 kg/m^2 (BMI = weight [kg]/(height [m])^2). Exclusion Criteria: • Have an active infection that required parenteral antibiotics or hospitalization within 2 weeks prior to enrollment; A history of or documented gastrointestinal diseases that impact drug absorption; Have a significant documented sulfa allergy (e.g., Stevens-Johnson Syndrome) or a history of sensitivity to any of the study medications, or components thereof; HIV, Hepatitis B or C positive Cigarette/cigar/pipe smokers; History of alcohol/drug abuse or dependence within 12 months of the study, or a history of alcohol consumption in the past six months exceeding 7 units/week for women and 14 units/week for men (where 1 unit = 5 ounces of wine or 12 ounces of beer or 1.5 ounces of hard liquor). Treatment with an investigational drug within 30 days or 5 half-lives (whichever is longer) preceding the first dose of study medication. Use of prescription or non-prescription drugs (including aspirin and nonsteroidal antiinflammatory drug (NSAIDs), vitamins, herbal and dietary supplements within 7 days (or 14 days if the drug is a potential enzyme inducer, such as St. John's Wort) or 5 half-lives (whichever is longer) prior to the first dose of study medication, unless in the opinion of the investigator the medication will not interfere with the study procedures or compromise subject safety. Subjects who have donated plasma within 7 days prior to the screening visit or where participation in this study would result in donation of blood in excess of 500 mL of blood within 56 day period.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 64 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Group A<br>Period 1-Maraviroc 300mg BID Period 2- Fosamprenavir 1400mg BID Period 3- Fosamprenavir 1400mg BID + Maraviroc 300mg BID | Drug: Maraviroc<br>* 300 mg BID<br>Drug: Fosamprenavir<br>* 1400 mg BID, 700 mg BID or 1400 mg QD<br>* Other names: Lexiva;|
| Active Comparator: Group B<br>Period 1-Maraviroc 300mg BID Period 2-Fosamprenavir 1400mg BID + Maraviroc 300mg BID Period 3-Fosamprenavir 1400mg BID | Drug: Maraviroc<br>* 300 mg BID<br>Drug: Fosamprenavir<br>* 1400 mg BID, 700 mg BID or 1400 mg QD<br>* Other names: Lexiva;|
| Active Comparator: Group C<br>Period 1-Maraviroc 300mg BID Period 2-Fosamprenavir 700mg BID + Ritonavir 100mg BID Period 3-Fosamprenavir 700mg BID + Ritonavir 100mg BID + Maraviroc 300mg BID | Drug: Maraviroc<br>* 300 mg BID<br>Drug: Fosamprenavir<br>* 1400 mg BID, 700 mg BID or 1400 mg QD<br>* Other names: Lexiva;Drug: Ritonavir<br>* 100 mg BID, 100 mg QD<br>* Other names: Norvir;|
| Active Comparator: Group D<br>Period 1-Maraviroc 300mg BID Period 2-Fosamprenavir 700mg BID + Ritonavir 100mg BID + Maraviroc 300mg BID Period 3-Fosamprenavir 700mg BID + Ritonavir 100mg BID | Drug: Maraviroc<br>* 300 mg BID<br>Drug: Fosamprenavir<br>* 1400 mg BID, 700 mg BID or 1400 mg QD<br>* Other names: Lexiva;Drug: Ritonavir<br>* 100 mg BID, 100 mg QD<br>* Other names: Norvir;|
| Active Comparator: Group E<br>Period 1-Maraviroc 300mg BID Period 2-Fosamprenavir 1400mg QD + Ritonavir 100mg QD Period 3- Fosamprenavir 1400mg QD + Ritonavir 100mg QD + Maraviroc 300mg BID | Drug: Maraviroc<br>* 300 mg BID<br>Drug: Fosamprenavir<br>* 1400 mg BID, 700 mg BID or 1400 mg QD<br>* Other names: Lexiva;Drug: Ritonavir<br>* 100 mg BID, 100 mg QD<br>* Other names: Norvir;|
| Active Comparator: Group F<br>Period 1-Maraviroc 300mg BID Period 2-Fosamprenavir 1400mg QD + Ritonavir 100mg QD + Maraviroc 300mg BID Period 3-Fosamprenavir 1400mg QD + Ritonavir 100mg QD | Drug: Maraviroc<br>* 300 mg BID<br>Drug: Fosamprenavir<br>* 1400 mg BID, 700 mg BID or 1400 mg QD<br>* Other names: Lexiva;Drug: Ritonavir<br>* 100 mg BID, 100 mg QD<br>* Other names: Norvir;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cmin/Cmax: Steady-state Plasma Amprenavir (APV) Pharmacokinetics ( PK) Following Admin of Fosamprenavir (FPV) 1400mg BID, FPV 700mg/Ritonavir (RTV) 100 mg BID, or FPV 1400mg/RTV 100mg QD With and Without Concurrent (Maraviroc) MVC 300mg BID. | Amprenavir (APV) is the active ingredient/metabolite of Fosamprenavir (FPV). | Day 14 of the FPV 1400mg BID, FPV 1400mg/MVC 300mg BID, FPV 700mg/RTV 100mg BID, FPV 700mg/RTV 100mg/MVC 300mg BID, FPV 1400mg/RTV 100mg QD, and FPV 1400mg/RTV 100mg QD plus MVC 300mg BID regimens | 
| AUC: Steady-state Plasma Amprenavir (APV) Pharmacokinetics ( PK) Following Admin of Fosamprenavir (FPV) 1400mg BID, FPV 700mg/Ritonavir (RTV) 100 mg BID, or FPV 1400mg/RTV 100mg QD With and Without Concurrent (Maraviroc) MVC 300mg BID. | Amprenavir (APV) is the active ingredient/metabolite of Fosamprenavir (FPV). | Day 14 of the FPV 1400mg BID, FPV 1400mg/MVC 300mg BID, FPV 700mg/RTV 100mg BID, FPV 700mg/RTV 100mg/MVC 300mg BID, FPV 1400mg/RTV 100mg QD, and FPV 1400mg/RTV 100mg QD plus MVC 300mg BID regimens | 
| Cmin/Cmax: Steady-state Plasma MVC PK Following Administration of RTV | Amprenavir (APV) is the active ingredient/ metabolite of Fosamprenavir (FPV). MVC minimum concentration (Cmin), maximum concentration (Cmax), and area under the plasma concentration-time curve (AUC), as determined from MVC concentrations observed in blood samples obtained at baseline, and at 0.5, 1, 1.5, 2, 3, 4, 6, 8, and 12 hours during the period when MVC 300mg BID was administered with the FPV-Containing BID regimens (FPV 1400mg BID, FPV 700mg/RTV 100 mg BID), and at 0.5, 1, 1.5, 2, 3, 4, 6, 8, and 24 hours during the period when MVC 300mg BID was administered with the FPV QD regimen (FPV 1400mg/RTV 100mg QD). As Groups A and B received the same regimens (albeit in different order), PK data for these two groups were collated, then assessed. For the same reason, PK data from Groups C and D regimens were collated before assessment, as were the PK data from Groups E and F. | Day 7 of the MVC 300mg BID regimen and Day 14 of the MVC 300mg/FPV 1400mg BID, MVC 300mg/FPV 700mg/RTV 100mg BID, and MVC 300mg BID Plus FPV 1400mg/RTV 100mg QD regimens | 
| AUC: Steady-state Plasma MVC PK Following Administration of RTV | Amprenavir (APV) is the active ingredient/ metabolite of Fosamprenavir (FPV). MVC minimum concentration (Cmin), maximum concentration (Cmax), and area under the plasma concentration-time curve (AUC), as determined from MVC concentrations observed in blood samples obtained at baseline, and at 0.5, 1, 1.5, 2, 3, 4, 6, 8, and 12 hours during the period when MVC 300mg BID was administered with the FPV-Containing BID regimens (FPV 1400mg BID, FPV 700mg/RTV 100 mg BID), and at 0.5, 1, 1.5, 2, 3, 4, 6, 8, and 24 hours during the period when MVC 300mg BID was administered with the FPV QD regimen (FPV 1400mg/RTV 100mg QD). As Groups A and B received the same regimens (albeit in different order), PK data for these two groups were collated, then assessed. For the same reason, PK data from Groups C and D regimens were collated before assessment, as were the PK data from Groups E and F. | Day 7 of the MVC 300mg BID regimen and Day 14 of the MVC 300mg/FPV 1400mg BID, MVC 300mg/FPV 700mg/RTV 100mg BID, and MVC 300mg BID Plus FPV 1400mg/RTV 100mg QD regimens | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants Who Experienced an Adverse Event | Safety/tolerability data collected included all adverse events (AEs) reported within the time frame of each regimen evaluated. The intent was to compare adverse events for each sequence and not for each regimen. The regimens for which AE information was culled were: MVC 300mg BID alone FPV 1400mg BID alone FPV 700mg/RTV 100 mg BID alone FPV 1400mg/RTV 100mg QD alone FPV 1400mg BID combined with MVC 300mg BID FPV 700mg/RTV 100 mg BID combined with MVC 300mg BID FPV 1400mg/RTV 100mg QD combined with MVC 300mg BID The severity of reported AEs was graded according to DAIDS criteria, Version 1.0 (National Institute of Allergy and Infectious Diseases (NIAID). Table for Grading the Severity of Adult and Pediatric Adverse Events, Version 1.0. Division of Acquired Immunodeficiency Syndrome (DAIDS), Washington D.C.; 2004 | Day 0 through Day 49 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Healthy Subjects, Pharmacokinetics study, Pharmacokinetics of medications