The aim of the POLO study is to evaluate pharmacokinetics and safety of a single-dose of dolutegravir in patients with severe hepatic impairment (Child-Pugh score * 10) and compare these to matched controls.
ID
Source
Brief title
Condition
- Viral infectious disorders
Synonym
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
Geometric Mean and the 95% classical confidence interval of AUC0-24h, Cmax,
C24h and median (range) of tmax for dolutegravir and dolutegravir glucuronide
in hepatic impaired subjects.
Geometric Mean and the 95% classical confidence interval of CUnbound DTG, t=3h
and CUnbound DTG, t=24h after administration.
Secondary outcome
(Serious) Adverse Events
Background summary
Currently, there are no data on the pharmacokinetics of dolutegravir in
patients with severe hepatic impairment. This is unfortunate as dolutegravir as
part of combination antiretroviral therapy for treamtent of HIV-infection in
patients with severe hepatic impairment has some advantages over other
frequently used antiretroviral agents. For example, dolutegravir has a limited
potential for causing drug-drug interactions, has a better tolerability profile
and its metabolism is probably minimally affected by liver dysfunction.
Study objective
The aim of the POLO study is to evaluate pharmacokinetics and safety of a
single-dose of dolutegravir in patients with severe hepatic impairment
(Child-Pugh score * 10) and compare these to matched controls.
Study design
Open-label, parallel-group, nonrandomized, multi-centre, phase-I, single dose
trial.
Intervention
A single dose of 50mg of dolutegravir will be given to participants on an empty
stomach around 8 AM. Breakfast will be provided 2h later. Plasma sampling will
be done for 96h (at t=0 (pre-dose), 0.5, 1, 2, 3, 4, 5, 6, 8, 10, 12, 24, 48,
72 and 96 hours post ingestion). A final safety assessment will be scheduled 7
days after drug intake (Day 8 +/- 2 days).
Study burden and risks
The study participants are all HIV-seronegative subjects and will not bene-fit
from the participation in this clinical trial.
Participants will visit the clinical research centre or hospital for a
screening visit, 1 full day (13 hours/24 hours) and 5 or 4 short visits (10
minutes). The duration of the entire trial (excluding screening period) is 8
(+/- 2 days) days maximum. Exposure to the study medication after a single dose
is 2-5 days, depending on the elimination half-life.
Dolutegravir has a good benefit/risk ratio. Its safety was demonstrated in a
study in 8 patients with moderate hepatic impairment and 8 matched controls
(Song et al 2013). For pharmacokinetic purposes 17 blood samples will be taken
in total. For safety assessment a total of 17 to 20 blood samples will be
collected (depending on which group, matched controls or hepatic impairment
group). The total blood volume taken during the entire study will be
approximately 120-130 mL of blood. During the days that blood samples will be
collected for a pharmacokinetic curve an intravenous cannula will be inserted
to facilitate blood sampling and limit the number of venous punctions.
Risk assessment is *minimal*. The risk-classification based on NFU-guidelines
is assessed as minimal to the subject population receiving study drug at the
selected regimen. Patients with severe hepatic impairment are a vulnerable
group. However, the study drug will be administered as a single dose only and
subjects will be monitored closely. In addition, dolutegravir is considered to
be safe and well tolerated in HIV-infected subjects and also in healthy
volunteers with or without moderate hepatic impairment. The drug is licensed on
the Dutch market for the dose administered (50mg QD). Also, a higher
dolutegravir dose (50mg BID) is licensed. Therefore the risk is assessed as
minimal to both matched controls and subjects with hepatic impairment.
Geert Grooteplein Zuid 10
Nijmegen 6525GA
NL
Geert Grooteplein Zuid 10
Nijmegen 6525GA
NL
Listed location countries
Age
Inclusion criteria
Hepatic impairment group:
1. Subject is at least 18 and not older than 90 years at screening.
2. Subject is able and willing to sign the Informed Consent Form prior to screening evaluations.
3. Child-Pugh score 10 or greater (Appendix A). Expected to be in clinical stable condition for at least 4 weeks as assessed by the subject*s own hepatologist. This assessment takes into account the following aspects: MELD score, fibroscan results (if available), life expectancy, recent history of decompensation events and the rate of progression of hepatic insufficiency.;Matched controls:
1. Subject is at least 18 and not older than 90 years at screening.
2. Subject is able and willing to sign the Informed Consent Form prior to screening evaluations.
3. Subject is in good age-appropriate health condition as established by medical history, physical examination, electrocardiography, results of biochemistry, haematology and urinalysis testing within 4 weeks prior to Day 1. Results of biochemistry, haematology and urinalysis testing should be within the laboratory's reference ranges (see Appendix D). If laboratory results are not within the reference ranges, the subject is in-cluded on condition that the Investigator judges that the deviations are not clinically relevant. This should be clearly recorded.
4. Subject has a normal blood pressure and pulse rate, according to the Investigator's judgement.
Exclusion criteria
Hepactic impairment group:
1. Inability to understand the nature and extent of the study and the pro-cedures required.
2. Gilbert*s syndrome or other underlying disease (other than hepatic impairment) that causes alterations in the Child-Pugh class components (bilirubin, albumin, protombin, encephalopathy and ascites).
3. Therapy with strong inducers or inhibitors of UGT1A1 or drugs that are contra-indicated with concomitant use of dolutegravir (see appendix B). (NB. there are restrictions for intake of magnesium/aluminium-containing antacids, iron and calcium supplements, multivitamins and other cation-containing supplements.
4. Positive HIV test.
5. Participation in a drug study within 60 days prior to Day 1.
6. Febrile illness within 3 days before Day 1.;Matched controls:
1. Documented history of sensitivity/idiosyncrasy to medicinal products or excipients.
2. Positive HIV test.
3. Positive hepatitis B or C test.
4. Pregnant female (as confirmed by an hCG test performed less than 4 weeks before Day 1) or breast-feeding female. Female subjects of childbearing potential without adequate contraception (see Appendix C).
5. Therapy with strong inducers or inhibitors of UGT1A1 or drugs that are contra-indicated with concomitant use of dolutegravir (see appendix B). (NB. there are restrictions for intake of magnesium/aluminium-containing antacids, iron- and calciumsupplements, multivitamins and other cation-containing supplements.
6. Relevant history or presence of pulmonary disorders (especially COPD), cardiovascular disorders, neurological disorders (especially seizures and migraine), psychiatric disorders, gastro-intestinal disor-ders, renal and hepatic disorders, hormonal disorders (especially dia-betes mellitus), coagulation disorders.
7. Relevant history or current condition that might interfere with drug absorption, distribution, metabolism or excretion.
8. History of or current abuse of drugs, alcohol or solvents.
9. Inability to understand the nature and extent of the study and the pro-cedures required.
10. Participation in a drug study within 60 days prior to Day 1.
11. Donation of blood within 60 days prior to Day 1.
12. Febrile illness within 3 days before Day 1
13. UGT1A1 polymorphism (at least one *28, *37 or *6 allele)
Design
Recruitment
Medical products/devices used
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
Register | ID |
---|---|
EudraCT | EUCTR2016-001349-21-NL |
CCMO | NL57349.078.17 |