TY - JOUR
T1 - Long-acting cabotegravir pharmacokinetics with and without oral lead-in for HIV PrEP
AU - Han, Kelong
AU - Patel, Parul
AU - McCallister, Scott
AU - Rinehart, Alex R.
AU - Gandhi, Yash
AU - Spreen, William
AU - Landovitz, Raphael J.
AU - Delany-Moretlwe, Sinead
AU - Marzinke, Mark A.
AU - McKeon, Todd
AU - Budnik, Piotr
AU - van Wyk, Jean
AU - Ford, Susan L.
N1 - Publisher Copyright:
© 2024 Han et al.
PY - 2024/6
Y1 - 2024/6
N2 - Long-acting cabotegravir is approved for pre-exposure prophylaxis and combination HIV treatment, both initiated with optional short-term oral lead-in (OLI). We evaluated the impact of OLI on long-acting cabotegravir pharmacokinetics. Cabotegravir plasma concentrations were compared between HIV-positive participants initiating injections with (n = 278) or without (n = 110) OLI in phase III treatment study FLAIR and in HIV-negative participants using OLI (n = 263) in pivotal pre-exposure prophylaxis studies HPTN 083 and HPTN 084. Cabotegravir pharmacokinetic profileswere simulated in three populations (assigned-male-at-birth, 50%-assigned-female-at-birth, and assigned-female-at-birth) under three scenarios: firstinjection given (A) 1 or (B) 3 days after finalOLI dose (OLI-injection gap) or (C) without OLI. The PK objective was 80% of participants achieving 4× in vitro protein-adjusted 90% maximal inhibitory concentration (PA-IC90) and 50% achieving 8× PA-IC90. Observed trough concentrations (Cτ) were similar with and without OLI (P > 0.3). With a 3-day OLI-injection gap, simulated pre-injection Cτ remained above PK objective. Approximately 1-2 weeks after the firstinjection, simulated PK profilesbecame nearly identical among all scenarios. Without OLI, it was predicted that 80% of participants achieve 4× PA-IC90 in 1.2, 1.8, and 2.8 days after the firstinjection in each population, respectively, and 50% achieve 8× PA-IC90 in 1.4, 2.1, and 3.8 days, respectively. Observed long-acting cabotegravir exposure was similar with or without OLI, supporting optional OLI use. Cabotegravir exposure was predicted to remain above PK objective for OLI-injection gaps of ≤3 days and rapidly achieve PK objective after firstinjection without OLI. Findings are consistent between assigned-male-at-birth and assigned-female-at-birth populations.
AB - Long-acting cabotegravir is approved for pre-exposure prophylaxis and combination HIV treatment, both initiated with optional short-term oral lead-in (OLI). We evaluated the impact of OLI on long-acting cabotegravir pharmacokinetics. Cabotegravir plasma concentrations were compared between HIV-positive participants initiating injections with (n = 278) or without (n = 110) OLI in phase III treatment study FLAIR and in HIV-negative participants using OLI (n = 263) in pivotal pre-exposure prophylaxis studies HPTN 083 and HPTN 084. Cabotegravir pharmacokinetic profileswere simulated in three populations (assigned-male-at-birth, 50%-assigned-female-at-birth, and assigned-female-at-birth) under three scenarios: firstinjection given (A) 1 or (B) 3 days after finalOLI dose (OLI-injection gap) or (C) without OLI. The PK objective was 80% of participants achieving 4× in vitro protein-adjusted 90% maximal inhibitory concentration (PA-IC90) and 50% achieving 8× PA-IC90. Observed trough concentrations (Cτ) were similar with and without OLI (P > 0.3). With a 3-day OLI-injection gap, simulated pre-injection Cτ remained above PK objective. Approximately 1-2 weeks after the firstinjection, simulated PK profilesbecame nearly identical among all scenarios. Without OLI, it was predicted that 80% of participants achieve 4× PA-IC90 in 1.2, 1.8, and 2.8 days after the firstinjection in each population, respectively, and 50% achieve 8× PA-IC90 in 1.4, 2.1, and 3.8 days, respectively. Observed long-acting cabotegravir exposure was similar with or without OLI, supporting optional OLI use. Cabotegravir exposure was predicted to remain above PK objective for OLI-injection gaps of ≤3 days and rapidly achieve PK objective after firstinjection without OLI. Findings are consistent between assigned-male-at-birth and assigned-female-at-birth populations.
KW - cabotegravir
KW - HIV
KW - oral lead-in
KW - pharmacokinetics
KW - pre-exposure prophylaxis
UR - http://www.scopus.com/inward/record.url?scp=85195178964&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85195178964&partnerID=8YFLogxK
U2 - 10.1128/aac.01475-23
DO - 10.1128/aac.01475-23
M3 - Article
C2 - 38709006
AN - SCOPUS:85195178964
SN - 0066-4804
VL - 68
JO - Antimicrobial agents and chemotherapy
JF - Antimicrobial agents and chemotherapy
IS - 6
ER -