Pharmacokinetics and Pharmacodynamics of Once-Daily versus Twice-Daily Raltegravir in Treatment-Naïve HIV-Infected Patients
Open Access
- 1 June 2012
- journal article
- Published by American Society for Microbiology in Antimicrobial Agents and Chemotherapy
- Vol. 56 (6), 3101-3106
- https://doi.org/10.1128/aac.06417-11
Abstract
QDMRK was a phase III clinical trial of raltegravir given once daily (QD) (800-mg dose) versus twice daily (BID) (400 mg per dose), each in combination with once-daily coformulated tenofovir-emtricitabine, in treatment-naive HIV-infected patients. Pharmacokinetic (PK) and pharmacokinetic/pharmacodynamic (PK/PD) analyses were conducted using a 2-step approach: individual non-model-based PK parameters from observed sparse concentration data were determined, followed by statistical analysis of potential relationships between PK and efficacy response parameters after 48 weeks of treatment. Sparse PK sampling was performed for all patients (QD, n = 380; BID, n = 384); selected sites performed an intensive PK evaluation at week 4 (QD, n = 22; BID, n = 20). In the intensive PK subgroup, daily exposures (area under the concentration-time curve from 0 to 24 h [AUC 0–24 ]) were similar between the two regimens, but patients on 800 mg QD experienced ∼4-fold-higher maximum drug concentration in plasma ( C max ) values and ∼6-fold-lower trough drug concentration ( C trough ) values than those on 400 mg BID. Geometric mean (GM) C trough values were similarly lower in the sparse PK analysis. With BID dosing, there was no indication of any significant PK/PD association over the range of tested PK parameters. With QD dosing, C trough values correlated with the likelihood of virologic response. Failure to achieve an HIV RNA level of C trough in the 800-mg-QD arm, though other possible drivers of efficacy, such as time above a threshold concentration, could not be evaluated due to the sparse sampling scheme. Together, these findings emphasize the importance of the shape of the plasma concentration-versus-time curve for long-term efficacy.Keywords
This publication has 18 references indexed in Scilit:
- Raltegravir once daily or twice daily in previously untreated patients with HIV-1: a randomised, active-controlled, phase 3 non-inferiority trialThe Lancet Infectious Diseases, 2011
- Sustained Antiretroviral Effect of Raltegravir After 96 Weeks of Combination Therapy in Treatment-Naive Patients With HIV-1 InfectionJAIDS Journal of Acquired Immune Deficiency Syndromes, 2009
- Safety and efficacy of raltegravir-based versus efavirenz-based combination therapy in treatment-naive patients with HIV-1 infection: a multicentre, double-blind randomised controlled trialThe Lancet, 2009
- Subgroup and Resistance Analyses of Raltegravir for Resistant HIV-1 InfectionThe New England Journal of Medicine, 2008
- Raltegravir with Optimized Background Therapy for Resistant HIV-1 InfectionThe New England Journal of Medicine, 2008
- Rapid and Durable Antiretroviral Effect of the HIV-1 Integrase Inhibitor Raltegravir as Part of Combination Therapy in Treatment-Naive Patients With HIV-1 InfectionJAIDS Journal of Acquired Immune Deficiency Syndromes, 2007
- Determination of the HIV integrase inhibitor, MK-0518 (raltegravir), in human plasma using 96-well liquid–liquid extraction and HPLC-MS/MSJournal of Chromatography B, 2007
- Safety, Tolerability, and Pharmacokinetics of Raltegravir After Single and Multiple Doses in Healthy SubjectsClinical Pharmacology & Therapeutics, 2007
- Safety and efficacy of the HIV-1 integrase inhibitor raltegravir (MK-0518) in treatment-experienced patients with multidrug-resistant virus: a phase II randomised controlled trialThe Lancet, 2007
- Antiviral Activity, Pharmacokinetics, and Dose Response of the HIV-1 Integrase Inhibitor GS-9137 (JTK-303) in Treatment-Naive and Treatment-Experienced PatientsJAIDS Journal of Acquired Immune Deficiency Syndromes, 2006