- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01813162
In Vivo Drug Interaction Pharmacokinetic Study of Tenofovir 1% Gel and Three Commonly Used Vaginal Products
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
This study consists of three separate crossover studies, each evaluating if local release characteristics and systemic exposure to TFV 1% gel and a given vaginal product are impacted by concomitant use. Vaginal products to be assessed are: antifungal cream, antimicrobial gel, and the combination contraceptive vaginal ring (IVR). There will be no comparison between vaginal product groups.
Participants will be randomized to vaginal product. Participants in the cream and gel cohorts will be randomized to the order of treatment conditions (TFV gel alone, vaginal product alone, and TFV gel and vaginal product concomitantly). Participants in the IVR cohort will use TFV gel alone during the first crossover period; the order of the remaining treatment conditions (IVR alone, TFV and IVR concomitantly) for crossover periods 2 and 3 will be randomly assigned.
Each participant will attend a total of at least 7 visits. At the first visit, volunteers will be consented and will undergo procedures to assess whether they are eligible to continue in the study. If eligible, they will undergo 3 crossover treatment periods. Within each crossover treatment period there will be 2 visits, which will be scheduled to occur within the same menstrual cycle; the first visit will be in the follicular phase of the menstrual cycle such that product use is initiated on cycle day 9 to 18 and the second visit will be on cycle day 16 to 24.
At the start of crossover period 1, after it has been confirmed that the participant meets all of the inclusion criteria and none of the exclusion criteria, she will be randomized to a vaginal product cohort and to a sequence of the treatment conditions for the 3 crossover periods. Crossover periods 2 and 3 will be scheduled in the subsequent menstrual cycles, with the first visit of each crossover period occurring approximately 2 weeks after the completion of the previous crossover period.
Product usage during the 3 crossover periods is as follows:
- Treatment Condition (vaginal product alone): The participant will be instructed to use her assigned product for 5 to 21 days, depending on the dosing instructions for the particular product cohort to which she has been assigned . The second visit of the crossover period will occur after product use is complete. For participants using antifungal cream or antimicrobial gel, blood specimens will be collected approximately 6 hours after the last gel or cream use. In the IVR cohort, blood specimens will be collected after 21 days of use at 0/4, 6, 10, and 24 hours. The 0/4 hour collection time point is the time of the first plasma draw. It is meant to mimic the 4 hour post-TFV gel insertion collection time point described below for the TFV gel alone and the vaginal product/TFV gel treatment conditions. No biopsies will be collected during the vaginal product treatment condition for all cohorts.
- Treatment Condition (TFV gel alone): The participant will be instructed to use TFV gel for 7 days, inserted twice a day with each dose approximately 12 hours apart. The second visit of the crossover period will occur after product use is complete. Blood specimens will be collected approximately 4 hours after the last dose of TFV gel. In the IVR cohort, participants will have blood specimens collected 4, 6, 10 and 24 hours after the last dose of TFV gel. Vaginal biopsy will be scheduled to take place approximately 6 hours after the last dose of TFV gel for all cohorts.
- Treatment Condition (vaginal product and TFV gel): The participant will be instructed to use her assigned product for 5 to 21 days, depending on the dosing instructions for the particular product cohort to which she has been assigned. TFV gel will be used for 7 days, inserted twice a day with each dose approximately 12 hours apart; the morning insertion of TFV gel will occur approximately two hours after insertion of the vaginal product (for the gel and cream cohorts). The second visit of the crossover period will occur after product use is complete. In the gel and or cream cohorts, blood specimens will be collected approximately 4 hours after the last TFV gel use. In the IVR cohort, blood specimens will be collected 4, 6, 10 and 24 hours after the last dose of TFV gel. Vaginal biopsy will be scheduled to take place approximately 6 hours after the last dose of TFV gel for all cohorts.
Each participant will be contacted by phone approximately 1-2 weeks after completion of crossover period 3 to confirm that there have been no additional adverse experiences. If necessary, she may be seen in an unscheduled visit for follow-up. She will then be exited from the study.
Study Type
Enrollment (Actual)
Phase
- Phase 1
Contacts and Locations
Study Locations
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California
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San Francisco, California, United States
- Dept of OBGYN and Reproductive Sciences, UCSF
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New York
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Bronx, New York, United States
- Bronx-Lebanon Hospital Center
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Age 18-50 years, inclusive
- General good health (by volunteer history and per investigator discretion)
- History of and currently regular menstrual cycles
- Willing to abstain from the use of vaginal products, other than the TFV gel and her assigned study vaginal product for the duration of the study.
- Willing to abstain from sex and other vaginal activity during each crossover period starting 72 hours prior to initiating product use, for the duration of use, and until the sixth day following sample collection
- At low risk for pregnancy due to surgical sterilization of participant and/or her sexual partner, use of copper IUD or male condom, abstinence, or same sex relationship
- Vaginal and cervical anatomy that, in the opinion of the investigator, lends itself to easy genital tract sample collection
- History of Pap smears and follow-up consistent with ACOG practice guidelines
- Negative urine pregnancy test
- Willing to give voluntary consent, sign an informed consent form and comply with study procedures as required by the protocol
Exclusion Criteria:
- History of hysterectomy
- Currently pregnant/within 2 calendar months from the last pregnancy outcome.
- Use of Depo-Provera in the last 120 days or any hormonal contraceptives in the last month
- Currently breastfeeding or having breastfed an infant in the last 2 months, or planning to breastfeed during the course of the study
History of sensitivity/allergy to any component of:
- TFV 1% gel; or
- topical anesthetic, or allergy to both silver nitrate and Monsel's solution.
- Contraindication to any of 3 vaginal products (antifungal cream, antimicrobial gel, or the combination contraceptive vaginal ring) to which participants may be randomized
- In the last 6 months, diagnosed with or treated for any STI or pelvic inflammatory disease, by self report.
- Symptomatic BV
- Positive test for Trichomonas vaginalis at Visit 1
- Positive test for Neisseria gonorrhea or Chlamydia trachomatis
- Positive test for HIV
- Positive test for Hepatitis B surface antigen (HBsAg)
- Known bleeding disorder that could lead to prolonged or continuous bleeding with biopsy
- Chronic or acute vulvar or vaginal symptoms
- Known current drug or alcohol abuse which could impact study compliance
- Grade 2 or higher laboratory abnormality, per the August 2009 update of the DAIDS Table for Grading the Severity of Adverse Events
- Systemic use in the last 2 weeks or anticipated use during the study of any of the following: corticosteroids, antibiotics, anticoagulants or other drugs known to prolong bleeding and or clotting, antifungals, antivirals (e.g., acyclovir or valacyclovir) or antiretrovirals (e.g., Viread®).
- Participation in any other drug or device interventional investigational trial (device, drug, or vaginal trial) within 30 days of this study or planned participation in any other investigational trial during the study
- History of gynecological procedures (including genital piercing) on the external genitalia, vagina or cervix within the last 14 days
- Abnormal finding on laboratory or physical examination or a social or medical condition which, in the opinion of the investigator, would make participation in the study unsafe or would complicate interpretation of data
Study Plan
How is the study designed?
Design Details
- Allocation: Randomized
- Interventional Model: Crossover Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Tenofovir 1% gel
Participants will vaginally insert 1 applicator of TFV gel twice a day for 7 days, with each dose inserted approximately 12 hours after the previous dose (for a total of 13 doses).
Each applicator contains 4.4 gm of TFV 1% gel.
|
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Active Comparator: Vaginal product alone
Participants will use their assigned vaginal product for 5 to 21 days depending on the dosing instructions for the particular product:
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Other Names:
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Experimental: Vaginal product and Tenofovir 1% gel
Tenofovir gel: Participants will vaginally insert 1 applicator of TFV gel twice a day for 7 days, with each dose inserted approximately 12 hours after the previous dose (for a total of 13 doses). Each applicator contains 4.4 gm of TFV 1% gel. In addition, Participants will use their assigned vaginal product for 5 to 21 days depending on the dosing instructions for the particular product:
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Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
TFV concentrations in plasma and genital tissue and TFV-DP concentrations in genital tissue
Time Frame: Assessments will be after product use (see description)
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Vaginal product alone: Participant will use assigned product per dosing instructions (antifungal cream: 7 days; antimicrobial gel: 5 days; IVR: 21 days). In cream or gel cohorts, blood will be drawn 6 hrs after last use. In contraceptive ring cohort, blood will be drawn after 21 days of use at 0/4,6,10&24 hrs. TFV gel alone: Participant will use TFV gel for 7 days, inserted 2X a day. In cream/gel cohorts blood will be drawn 4 hrs after last TFV gel use. In contraceptive ring cohort blood will be drawn 4,6,10&24 hrs after last TFV gel use. Vaginal biopsy will occur 6 hrs after last TFV gel use for all. Vaginal product & TFV gel: Participant will use assigned product per dosing instructions. TFV gel will be used for 7 days, 2X a day. In gel/cream cohorts blood will be drawn 4 hrs after last TFV gel use. In contraceptive ring cohort blood will be drawn 4,6,10&24 hrs after last dose of TFV gel. Vaginal biopsy will occur 6 hrs after the last dose of TFV gel for all. |
Assessments will be after product use (see description)
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Vaginal product concentration in plasma
Time Frame: Assessments will be after product use (see description)
|
Vaginal product alone: Participant will use assigned product per dosing instructions (antifungal cream: 7 days; antimicrobial gel: 5 days; IVR: 21 days). In cream or gel cohorts, blood will be drawn 6 hrs after last use. In contraceptive ring cohort, blood will be drawn after 21 days of use at 0/4,6,10&24 hrs. TFV gel alone: Participant will use TFV gel for 7 days, inserted 2X a day. In cream/gel cohorts blood will be drawn 4 hrs after last TFV gel use. In contraceptive ring cohort blood will be drawn 4,6,10&24 hrs after last TFV gel use. Vaginal product & TFV gel: Participant will use assigned product per dosing instructions. TFV gel will be used for 7 days, 2X a day. In gel/cream cohorts blood will be drawn 4 hrs after last TFV gel use. In contraceptive ring cohort blood will be drawn 4,6,10&24 hrs after last dose of TFV gel. |
Assessments will be after product use (see description)
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Genitourinary adverse events (AEs)
Time Frame: Assessments will be after product use (see description)
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Vaginal product alone: Participant will use assigned product per dosing instructions (antifungal cream: 7 days; antimicrobial gel: 5 days; IVR: 21 days). Genitourinary AEs will be assessed by participant report and exam after completion of dosing. TFV gel alone: Participant will use TFV gel for 7 days, inserted 2X a day. Genitourinary AEs will be assessed by participant report and exam after completion of dosing. Vaginal product & TFV gel: Participant will use assigned product per dosing instructions. TFV gel will be used for 7 days, 2X a day. Genitourinary AEs will be assessed by participant report and exam after completion of dosing. |
Assessments will be after product use (see description)
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Collaborators and Investigators
Sponsor
Investigators
- Study Chair: Jill Schwartz, M.D., CONRAD
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Anti-Infective Agents
- Antiviral Agents
- Reverse Transcriptase Inhibitors
- Nucleic Acid Synthesis Inhibitors
- Enzyme Inhibitors
- Anti-HIV Agents
- Anti-Retroviral Agents
- Anti-Bacterial Agents
- Antifungal Agents
- Reproductive Control Agents
- Antiprotozoal Agents
- Antiparasitic Agents
- Tenofovir
- Metronidazole
- Contraceptive Agents
- Terconazole
Other Study ID Numbers
- A11-118
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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