- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04689737
Removal of Doravirine by Hemodialysis in HIV-Infected Patients With End-stage Renal Disease (ESRD)
July 6, 2021 updated by: Fundación FLS de Lucha Contra el Sida, las Enfermedades Infecciosas y la Promoción de la Salud y la Ciencia
Removal of Doravirine by Hemodialysis in HIV-Infected Patients With End-Stage Renal Disease (ESRD)
Doravirine is a novel non-nucleoside reverse transcriptase inhibitor that has demonstrated good efficacy, tolerability, and safety for the treatment of patients with HIV infection in phase III clinical trials.
Doravirine achieved non- inferiority when compared with efavirenz- and darunavir/ritonavir-based regimens.
Doravirine is mainly metabolized and eliminated by the liver, with only 6% of the drug being excreted unchanged through the urine.In a study comparing 8 subjects with severe renal disease to 8 subjects without renal impairment, the single dose exposure of doravirine was 43% higher in subjects with severe renal function impairment.However, according to prescribing information, no dosage adjustment of doravirine is required in patients with mild, moderate, or severe renal impairment.
On the other hand, data on doravirine pharmacokinetics in patients with ESRD on dialysis are lacking.
This may be of special interest because doravirine has a relatively low molecular weight and it is only 76% bound to proteins in plasma.
These characteristics could make possible for hemodialysis to remove doravirine from plasma, potentially leading to subtherapeutic concentrations of doravirine after the dialysis sessions.
On the contrary, doravirine volume of distribution is about 60 liters,15 what could limit extraction of doravirine by hemodialysis.
Since data on doravirine pharmacokinetics in PLWH with ESRD on dialysis are lacking, our aim is to evaluate the effect of intermittent hemodialysis on doravirine concentrations in HIV-infected patients with ESRD
Study Overview
Status
Completed
Intervention / Treatment
Detailed Description
Doravirine is a novel non-nucleoside reverse transcriptase inhibitor that has demonstrated good efficacy, tolerability, and safety for the treatment of patients with HIV infection in phase III clinical trials.
Doravirine achieved non- inferiority when compared with efavirenz- and darunavir/ritonavir-based regimens.
Doravirine is mainly metabolized and eliminated by the liver, with only 6% of the drug being excreted unchanged through the urine.In a study comparing 8 subjects with severe renal disease to 8 subjects without renal impairment, the single dose exposure of doravirine was 43% higher in subjects with severe renal function impairment.However, according to prescribing information, no dosage adjustment of doravirine is required in patients with mild, moderate, or severe renal impairment.
On the other hand, data on doravirine pharmacokinetics in patients with ESRD on dialysis are lacking.
This may be of special interest because doravirine has a relatively low molecular weight and it is only 76% bound to proteins in plasma.
These characteristics could make possible for hemodialysis to remove doravirine from plasma, potentially leading to subtherapeutic concentrations of doravirine after the dialysis sessions.
On the contrary, doravirine volume of distribution is about 60 liters,15 what could limit extraction of doravirine by hemodialysis.
Since data on doravirine pharmacokinetics in PLWH with ESRD on dialysis are lacking, our aim is to evaluate the effect of intermittent hemodialysis on doravirine concentrations in HIV-infected patients with ESRD.
Study Type
Interventional
Enrollment (Actual)
8
Phase
- Phase 4
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
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Barcelona, Spain, 08035
- Valle Hebrón Hospital
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Barcelona
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Badalona, Barcelona, Spain, 08916
- Germans Trias I Pujol Hospital
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Hospitalet de Llobregat, Barcelona, Spain, 08907
- Universitario Bellvitge Hospital
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years to 99 years (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Males and females* aging ≥ 18 years.
- Documented HIV infection).
- Stable antiretroviral treatment for at least 2 weeks prior to enrolment.
- Optimal adherence to antiretroviral treatment, defined as less than 2 missed doses within the previousweek.
- End-stage renal disease in renal replacement therapy with periodic hemodialysis.
- Agree with the study procedures and signature of the informed consent. *Women of childbearing potential must have a negative pregnancy test prior to randomization into the study and commitment to useat least one of these birth control methods: male or female condom with or without spermicide, cap, diaphragm or sponge with orwithout spermicide, intrauterine device, bilateral tubal occlusion, vasectomized partner, sexual abstinence during the study. Condomuse is considered as an additional method of contraception only and cannot be the only method of contraception used as not beenconsidered an effective method by the Clinical Trial Facilitation Group (CTFG) guidelines.
Based on ICH, M3 (R2) 2009 a woman is considered of childbearing potential: fertile, following menarche and until becoming post-menopausal unless permanently sterile. Permanent sterilization methods include tubal ligation, hysterectomy, bilateral oophorectomy.
Exclusion Criteria:
- Evidence or clinical suspicion that the patient will not be able to comply with the study protocol.
- Hypersensitivity to doravirine
Concomitant therapy within the previous 4 weeks with any of the following drugs:
- Anticonvulsants: carbamazepine, oxcarbazepine, phenobarbital, phenytoin
- Androgen receptor inhibitor: enzalutamide
- Antimycobacterials: rifampin, rifapentine
- Cytotoxic agent: mitotane
- St. John's wort (Hypericum perforatum)
- Females who are pregnant or breastfeeding.
- ALT and/ or AST ≥ 4 times the upper limit of normal (ULN) at screening.
- Hemoglobin < 7,5 g/dL at screening.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Other
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Experimental group
Doravirine (Pifeltro, MSD) will be added to participant's cART (100 mg once daily) for 5 days
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Participants will be told to take one tablet of doravirine (Pifeltro, MDS) once daily, with or without food, approximately at the day time that they usually finish the hemodialysis sessions.
The rest of their antiretroviral regimen and concomitant medications will remain unchanged
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Doravirine hemodialysis extraction ratio
Time Frame: At day 6
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% doravirina in blood samples entering ('Cin') and leaving ('Cout') the dialyzer collected during the dialysis session
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At day 6
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Doravirine Concentration in plasma at the beginning of dialysis session
Time Frame: At day 6
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mg/dl
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At day 6
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Percentage of participants developing related adverse events grade 3-4 related to doravirine
Time Frame: Baseline to day 20
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Baseline to day 20
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
March 20, 2021
Primary Completion (Actual)
June 14, 2021
Study Completion (Actual)
June 14, 2021
Study Registration Dates
First Submitted
December 29, 2020
First Submitted That Met QC Criteria
December 29, 2020
First Posted (Actual)
December 30, 2020
Study Record Updates
Last Update Posted (Actual)
July 7, 2021
Last Update Submitted That Met QC Criteria
July 6, 2021
Last Verified
July 1, 2021
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- Dora-HD
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
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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