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Safety and Pharmacokinetic Study of Tenofovir Alafenamide (TAF)/Elvitegravir (EVC) Administered Rectally

Primary Purpose

HIV Infections

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
TAF/EVG Insert
Sponsored by
National Institute of Allergy and Infectious Diseases (NIAID)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for HIV Infections

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • Individuals who are 18 years of age or older at Screening, verified per site standard operating procedure (SOP)
  • Able and willing to provide written informed consent to be screened for and enrolled in MTN-039
  • HIV-1/2 uninfected at Screening and Enrollment, per applicable algorithm in the study protocol and willing to receive HIV test results
  • Able and willing to provide adequate locator information, as defined in site SOP
  • Able to communicate in spoken and written English
  • Available for all visits and able and willing to comply with all study procedural requirements
  • In general good health at Screening and Enrollment, as determined by the site Investigator of Record (IoR) or designee
  • At Screening, history of consensual receptive anal intercourse (RAI) at least once in lifetime per participant report
  • Willing not to take part in other research studies involving drugs, medical devices, genital or rectal products, or vaccines for the duration of study participation (including the time between Screening and Enrollment)
  • Willing to comply with abstinence and other protocol requirements as outlined in the study protocol
  • For participants of childbearing potential: a negative pregnancy test at Screening and Enrollment
  • For participants of childbearing potential: Per participant report at Enrollment, using an effective method of contraception for at least 30 days (inclusive) prior to Enrollment and intending to use an effective method for the duration of study participation. Effective methods include:

    • Hormonal methods
    • Intrauterine device (IUD) inserted at least 30 days prior to Enrollment (but not past the maximum length of recommended usage according to package instructions)
    • Sterilization (of participant or partner, as defined in site SOPs)
    • Sexually abstinent as defined by abstaining from penile-vaginal intercourse for 90 days prior to Enrollment and intending to remain abstinent for the duration of study participation; this includes having sex exclusively with individuals assigned female sex at birth

Exclusion Criteria:

  • At Screening:

    • Hemoglobin Grade 1 or higher*
    • Platelet count Grade 1 or higher*
    • Aspartate aminotransferase (AST) or alanine transaminase (ALT) Grade 1 or higher*
    • Serum creatinine greater than 1.3 times the site laboratory upper limit of normal (ULN)
    • International normalized ratio (INR) greater than 1.5 times the site laboratory ULN
    • History of inflammatory bowel disease by participant report
    • Positive hepatitis B surface antigen (HBsAg) test result
    • *As per the Division of AIDS Table for Grading the Severity of Adult and Pediatric Adverse Events Corrected Version 2.1, July 2017.
    • Note: Otherwise eligible participants with an exclusionary test result (other than HIV) can be re-tested during the screening process. If a participant is re-tested and a non-exclusionary result is documented within 45 days of providing informed consent for screening, the participant may be enrolled.
  • Anticipated use of and/or unwillingness to abstain from the following medications during study participation:

    • Anticoagulant medications
    • Non-study rectally-administered medications and any products containing nonoxynol-9 (N-9)
  • Known adverse reaction to any of the components of the study product
  • Use of approved or other investigational pre-exposure prophylaxis (PrEP) for HIV prevention within 3 months prior to Enrollment, and/or anticipated use and/or unwillingness to abstain from PrEP during trial participation
  • Use of post-exposure prophylaxis (PEP) for potential HIV exposure within 6 months prior to Enrollment
  • Condomless RAI and/or penile-vaginal intercourse with a partner who is known to be HIV-positive or whose status is unknown in the 6 months prior to Enrollment
  • History of transactional sex in the 12 months prior to Enrollment
  • Non-therapeutic injection drug use or use of non-therapeutic, non-injection stimulant drugs in the 12 months prior to Enrollment
  • Participation in research studies involving drugs, medical devices, genital or rectal products, or vaccines within 30 days of the Enrollment Visit
  • Per participant report, medical records, clinical diagnosis and/or diagnostic testing at either Screening or Enrollment:

    • Diagnosis or treatment of an anogenital sexually transmitted infection (STI) in the 3 months prior to enrollment (including window between Screening and Enrollment).
    • Symptoms, clinical or laboratory diagnosis of active pharyngeal, anorectal, or reproductive tract infection (RTI) requiring treatment per current Centers for Disease Control and Prevention (CDC) guidelines (http://www.cdc.gov/std/treatment).
    • Current symptomatic urinary tract infection (UTI).

      • Infections requiring treatment include Neisseria gonorrhea (GC), Chlamydia trachomatis (CT) infection, syphilis, active herpes simplex virus (HSV) lesions, or symptomatic genital warts, chancroid, pelvic inflammatory disease (PID), bacterial vaginosis (BV), symptomatic vaginal candidiasis, and trichomoniasis.
      • Note: Otherwise eligible participants with an exclusionary UTI, BV and/or candida finding may be re-tested during the screening process.
  • For participants of childbearing potential: Pregnant or breastfeeding at either Screening or Enrollment or planning to become pregnant during study participation

    • Note: A documented negative pregnancy test performed by study staff is required for inclusion; however, a self-reported pregnancy is adequate for exclusion from screening/enrollment into the study.
  • For participants of childbearing potential: Last pregnancy outcome 90 days or less prior to Screening
  • Has any other condition that, in the opinion of the IoR/designee, would preclude informed consent, make study participation unsafe, complicate the interpretation of study outcome data, or otherwise interfere with achieving the study objectives including any significant uncontrolled active or chronic medical condition.

Sites / Locations

  • Alabama CRS
  • University of Pittsburgh CRS

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Tenofovir Alafenamide (TAF)/Elvitegravir (EVG) Insert

Arm Description

On the first dosing visit (Visit 3), participants will receive a single TAF/EVG Insert for rectal administration. On the second dosing visit (Visit 7), after a washout period of at least 7 days, participants will receive two TAF/EVG Inserts for rectal administration. Each participant will be on study for approximately 6-13 weeks.

Outcomes

Primary Outcome Measures

Frequency of all Grade 2 and higher adverse events (AEs)
Graded per the Division of AIDS (DAIDS) Table for Grading Adult and Pediatric Adverse Events, Corrected Version 2.1, July 2017 and/or Addenda 1, 2 and 3 (Female Genital [Dated November 2007], Male Genital [Dated November 2007] and Rectal [Clarification Dated May 2012] Grading Tables for Use in Microbicide Studies).
EVG concentrations in blood
Based on laboratory evaluations
EVG concentrations in rectal fluid
Based on laboratory evaluations
EVG concentrations in rectal mucosal tissue homogenates
Based on laboratory evaluations
TAF concentrations in blood
Based on laboratory evaluations
TAF concentrations in rectal fluid
Based on laboratory evaluations
TFV concentrations in blood
Based on laboratory evaluations
TFV concentrations in rectal fluid
Based on laboratory evaluations
TFV-DP concentration in rectal mucosal tissue homogenates
Based on laboratory evaluations
TFV-DP concentration in rectal mucosal tissue cell isolates
Based on laboratory evaluations
TFV concentration in rectal mucosal tissue homogenates
Based on laboratory evaluations

Secondary Outcome Measures

Percentage of participants who report of overall acceptability of the TAF/EVG Insert applied rectally
Based on participant report

Full Information

First Posted
August 5, 2019
Last Updated
May 2, 2023
Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)
Collaborators
CONRAD
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1. Study Identification

Unique Protocol Identification Number
NCT04047420
Brief Title
Safety and Pharmacokinetic Study of Tenofovir Alafenamide (TAF)/Elvitegravir (EVC) Administered Rectally
Official Title
A Phase 1 Open Label Safety and Pharmacokinetic Study of Rectal Administration of a Tenofovir Alafenamide/Elvitegravir Insert at Two Dose Levels
Study Type
Interventional

2. Study Status

Record Verification Date
May 2023
Overall Recruitment Status
Completed
Study Start Date
December 11, 2019 (Actual)
Primary Completion Date
March 3, 2021 (Actual)
Study Completion Date
April 7, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)
Collaborators
CONRAD

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to evaluate the safety and pharmacokinetics of rectal administration of a tenofovir alafenamide (TAF)/elvitegravir (EVG) insert at two dose levels in HIV-uninfected individuals.
Detailed Description
This study will evaluate the safety and pharmacokinetics of rectal administration of a tenofovir alafenamide (TAF)/elvitegravir (EVG) insert at two dose levels in HIV-uninfected individuals. All participants will receive a single TAF/EVG Insert at Study Visit 3. After a washout period of at least 7 days, participants will receive two TAF/EVG Inserts at Study Visit 7. The inserts will be administered rectally by study staff. After each dosing visit, samples will be collected over a 3-day period. Participants will attend 10 study visits and will be followed for approximately 6 to 13 weeks. Study visits may include physical and rectal examinations; collection of blood, urine, rectal and vaginal fluid; and interviews. The total duration of the study will be approximately 11 months.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
HIV Infections

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
23 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Tenofovir Alafenamide (TAF)/Elvitegravir (EVG) Insert
Arm Type
Experimental
Arm Description
On the first dosing visit (Visit 3), participants will receive a single TAF/EVG Insert for rectal administration. On the second dosing visit (Visit 7), after a washout period of at least 7 days, participants will receive two TAF/EVG Inserts for rectal administration. Each participant will be on study for approximately 6-13 weeks.
Intervention Type
Drug
Intervention Name(s)
TAF/EVG Insert
Intervention Description
TAF/EVG Insert (20/16 mg) administered rectally by study staff
Primary Outcome Measure Information:
Title
Frequency of all Grade 2 and higher adverse events (AEs)
Description
Graded per the Division of AIDS (DAIDS) Table for Grading Adult and Pediatric Adverse Events, Corrected Version 2.1, July 2017 and/or Addenda 1, 2 and 3 (Female Genital [Dated November 2007], Male Genital [Dated November 2007] and Rectal [Clarification Dated May 2012] Grading Tables for Use in Microbicide Studies).
Time Frame
Measured through Month 11
Title
EVG concentrations in blood
Description
Based on laboratory evaluations
Time Frame
Measured through Week 13
Title
EVG concentrations in rectal fluid
Description
Based on laboratory evaluations
Time Frame
Measured through Week 13
Title
EVG concentrations in rectal mucosal tissue homogenates
Description
Based on laboratory evaluations
Time Frame
Measured through Week 13
Title
TAF concentrations in blood
Description
Based on laboratory evaluations
Time Frame
Measured through Week 13
Title
TAF concentrations in rectal fluid
Description
Based on laboratory evaluations
Time Frame
Measured through Week 13
Title
TFV concentrations in blood
Description
Based on laboratory evaluations
Time Frame
Measured through Week 13
Title
TFV concentrations in rectal fluid
Description
Based on laboratory evaluations
Time Frame
Measured through Week 13
Title
TFV-DP concentration in rectal mucosal tissue homogenates
Description
Based on laboratory evaluations
Time Frame
Measured through Week 13
Title
TFV-DP concentration in rectal mucosal tissue cell isolates
Description
Based on laboratory evaluations
Time Frame
Measured through Week 13
Title
TFV concentration in rectal mucosal tissue homogenates
Description
Based on laboratory evaluations
Time Frame
Measured through Week 13
Secondary Outcome Measure Information:
Title
Percentage of participants who report of overall acceptability of the TAF/EVG Insert applied rectally
Description
Based on participant report
Time Frame
Measured through Week 13

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Individuals who are 18 years of age or older at Screening, verified per site standard operating procedure (SOP) Able and willing to provide written informed consent to be screened for and enrolled in MTN-039 HIV-1/2 uninfected at Screening and Enrollment, per applicable algorithm in the study protocol and willing to receive HIV test results Able and willing to provide adequate locator information, as defined in site SOP Able to communicate in spoken and written English Available for all visits and able and willing to comply with all study procedural requirements In general good health at Screening and Enrollment, as determined by the site Investigator of Record (IoR) or designee At Screening, history of consensual receptive anal intercourse (RAI) at least once in lifetime per participant report Willing not to take part in other research studies involving drugs, medical devices, genital or rectal products, or vaccines for the duration of study participation (including the time between Screening and Enrollment) Willing to comply with abstinence and other protocol requirements as outlined in the study protocol For participants of childbearing potential: a negative pregnancy test at Screening and Enrollment For participants of childbearing potential: Per participant report at Enrollment, using an effective method of contraception for at least 30 days (inclusive) prior to Enrollment and intending to use an effective method for the duration of study participation. Effective methods include: Hormonal methods Intrauterine device (IUD) inserted at least 30 days prior to Enrollment (but not past the maximum length of recommended usage according to package instructions) Sterilization (of participant or partner, as defined in site SOPs) Sexually abstinent as defined by abstaining from penile-vaginal intercourse for 90 days prior to Enrollment and intending to remain abstinent for the duration of study participation; this includes having sex exclusively with individuals assigned female sex at birth Exclusion Criteria: At Screening: Hemoglobin Grade 1 or higher* Platelet count Grade 1 or higher* Aspartate aminotransferase (AST) or alanine transaminase (ALT) Grade 1 or higher* Serum creatinine greater than 1.3 times the site laboratory upper limit of normal (ULN) International normalized ratio (INR) greater than 1.5 times the site laboratory ULN History of inflammatory bowel disease by participant report Positive hepatitis B surface antigen (HBsAg) test result *As per the Division of AIDS Table for Grading the Severity of Adult and Pediatric Adverse Events Corrected Version 2.1, July 2017. Note: Otherwise eligible participants with an exclusionary test result (other than HIV) can be re-tested during the screening process. If a participant is re-tested and a non-exclusionary result is documented within 45 days of providing informed consent for screening, the participant may be enrolled. Anticipated use of and/or unwillingness to abstain from the following medications during study participation: Anticoagulant medications Non-study rectally-administered medications and any products containing nonoxynol-9 (N-9) Known adverse reaction to any of the components of the study product Use of approved or other investigational pre-exposure prophylaxis (PrEP) for HIV prevention within 3 months prior to Enrollment, and/or anticipated use and/or unwillingness to abstain from PrEP during trial participation Use of post-exposure prophylaxis (PEP) for potential HIV exposure within 6 months prior to Enrollment Condomless RAI and/or penile-vaginal intercourse with a partner who is known to be HIV-positive or whose status is unknown in the 6 months prior to Enrollment History of transactional sex in the 12 months prior to Enrollment Non-therapeutic injection drug use or use of non-therapeutic, non-injection stimulant drugs in the 12 months prior to Enrollment Participation in research studies involving drugs, medical devices, genital or rectal products, or vaccines within 30 days of the Enrollment Visit Per participant report, medical records, clinical diagnosis and/or diagnostic testing at either Screening or Enrollment: Diagnosis or treatment of an anogenital sexually transmitted infection (STI) in the 3 months prior to enrollment (including window between Screening and Enrollment). Symptoms, clinical or laboratory diagnosis of active pharyngeal, anorectal, or reproductive tract infection (RTI) requiring treatment per current Centers for Disease Control and Prevention (CDC) guidelines (http://www.cdc.gov/std/treatment). Current symptomatic urinary tract infection (UTI). Infections requiring treatment include Neisseria gonorrhea (GC), Chlamydia trachomatis (CT) infection, syphilis, active herpes simplex virus (HSV) lesions, or symptomatic genital warts, chancroid, pelvic inflammatory disease (PID), bacterial vaginosis (BV), symptomatic vaginal candidiasis, and trichomoniasis. Note: Otherwise eligible participants with an exclusionary UTI, BV and/or candida finding may be re-tested during the screening process. For participants of childbearing potential: Pregnant or breastfeeding at either Screening or Enrollment or planning to become pregnant during study participation Note: A documented negative pregnancy test performed by study staff is required for inclusion; however, a self-reported pregnancy is adequate for exclusion from screening/enrollment into the study. For participants of childbearing potential: Last pregnancy outcome 90 days or less prior to Screening Has any other condition that, in the opinion of the IoR/designee, would preclude informed consent, make study participation unsafe, complicate the interpretation of study outcome data, or otherwise interfere with achieving the study objectives including any significant uncontrolled active or chronic medical condition.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Sharon A. Riddler, MD, MPH
Organizational Affiliation
University of Pittsburgh
Official's Role
Study Chair
Facility Information:
Facility Name
Alabama CRS
City
Birmingham
State/Province
Alabama
ZIP/Postal Code
35294
Country
United States
Facility Name
University of Pittsburgh CRS
City
Pittsburgh
State/Province
Pennsylvania
ZIP/Postal Code
15213
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
Undecided

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Safety and Pharmacokinetic Study of Tenofovir Alafenamide (TAF)/Elvitegravir (EVC) Administered Rectally

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