Rectal Insert TAF/EVG Pre-Exposure Prophylaxis (RITE PrEP) Study (RITE PrEP)

A Double-Blind, Placebo-Controlled, Randomized Phase 1 Study to Evaluate the Safety and Pharmacokinetics of Rectally Administered Tenofovir Alafenamide/Elvitegravir Inserts

This is a double-blind, placebo-controlled, randomized two-phase study to evaluate the safety and pharmacokinetics (PK) of two TAF/EVG inserts administered rectally for 3 consecutive days, then every other day for 14 days.

Study Overview

• Status: Recruiting
• Conditions: Safety Issues
• Intervention / Treatment: Drug: TAF/EVG rectal insert; Drug: Matching placebo rectal insert

Detailed Description

The purpose of this study is to collect data regarding the safety and pharmacokinetics of repeat dosing schedules of TAF and EVG administered rectally to inform the development of future studies to assess the efficacy of this drug combination and mode of administration for use as on-demand PrEP in individuals at risk of acquiring HIV-1 infection.

Eligible participants will be stratified according to sex assigned at birth and then randomized 1:1 to either receive TAF/EVG inserts or placebo for self-administration during the study phases. During Phase 1, participants will self-administer two TAF/EVG or placebo rectal inserts for 3 consecutive days and return to the clinic at 24, 48, and 72 hours after the last dose for biological sample collection. During Phase 2, participants will administer two TAF/EVG or placebo rectal inserts every other day for 7 doses and return to the clinic at 24 hours, 48 hours, 72 hours and 7 days after the final dose for biological sample collection. There will be a washout period of 7 to 28 days between the study phases.

• Study Type: Interventional
• Enrollment (Estimated): 24
• Phase: Phase 1

Contacts and Locations

• Study Contact: Name: Karen Dominguez, MPH; Phone Number: 757-446-5994; Email: domingk@evms.edu

Study Locations

• United States
  • Georgia
    • Atlanta, Georgia, United States, 30322
      • Recruiting
      • Emory Clinic
      • Contact: Cassie Grimsley Ackerley, MD, MSc; Email: cassie.marie.grimsley.ackerley@emory.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

1. Individuals between the ages of 18-59 years
2. Able to understand and give informed consent
3. HIV-negative and willing to be tested for HIV
4. Willing to undergo peripheral blood, urine, rectal secretion collection, and rectal biopsy sampling
5. For those assigned female at birth: Willing to undergo cervicovaginal secretion collection
6. Lifetime history of receptive anal intercourse
7. No contraindication to rectal biopsy (at the investigator's discretion)

8. For participants of childbearing potential: Willing to use an effective method of contraception for at least 30 days prior to enrollment and for the duration of study participation. Effective methods include:

   1. Hormonal methods
   2. Intrauterine device (IUD) inserted at least 30 days prior to enrollment
   3. Sterilization (of participant or partner)
   4. 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
   5. Willing to commit to using condoms for the duration of the study

Exclusion Criteria:

1. Currently infected with hepatitis virus and/or has liver disease
2. Current or chronic history of kidney disease or CrCl <60 ml/min
3. History of inflammatory bowel disease or other inflammatory, infiltrative, infectious, or vascular condition of the lower GI tract which at the judgement of the investigator, may be worsened by study procedures or may significantly distort the anatomy of the distal large bowel.

4. Significant laboratory abnormalities at baseline, including but not limited to:

   1. Hemoglobin ≤ 10 g/dL
   2. Platelet count <100,000
   3. Aspartate aminotransferase (AST) or alanine transaminase (ALT) >1.3x ULN
   4. Serum creatinine >1.3x upper limit of normal (ULN)
   5. PTT > 1.5x ULN or International normalized ratio (INR) >1.5x ULN

5. Any known medical condition that, in the judgement of the investigators, increases the risk of local or systemic complications of biopsy procedures or pelvic examination, including but not limited to:

   1. Uncontrolled or severe cardiac arrhythmia
   2. Recent major abdominal, cardiothoracic, or neurological surgery in the last 12 months
   3. History of uncontrolled bleeding diathesis
6. Current colonic, rectal, or cervicovaginal perforation, fistula, or malignancy
7. Current symptoms or evidence on clinical examination of ulcerative, suppurative, or proliferative lesions of the cervicovaginal and/or anorectal mucosa
8. Current symptoms or evidence on clinical examination of atypical rectal or vaginal discharge

9. Continued need for, or use during the 14 days prior to the rectal biopsy, of the following medications:

   1. Aspirin or more than 4 doses of NSAIDs
   2. Warfarin, heparin (LMW or unfractionated), platelet aggregation inhibitors, or fibrinolytic agents
   3. Any form of rectally administered medications or agents (excluding lubricants or douching)

10. Continued need for, or use during the 90 days prior to enrollment, of the following medications:

    1. Systemic immunomodulatory agents
    2. Supraphysiologic doses of steroids, except for short course steroids <7 days duration, at the discretion of the investigator
    3. Experimental medications, vaccines, or biologicals (except for COVID-19 vaccines available through the emergency use authorization)
11. Use of moderate or strong CYP inducers/inhibitors (see appendix I)
12. Known or suspected allergy to study product components
13. Use of 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
14. Use of post-exposure prophylaxis (PEP) for potential HIV exposure within 6 months prior to enrollment
15. Pregnant and breastfeeding persons, or intent to become pregnant within the next 6 months
16. Participation in other studies involving the use of drugs, medical devices, rectal and genital products, or vaccines within the past 90 days.
17. Any other clinical condition or prior therapy that, in the opinion of the investigator, would make the participant unsuitable for the study or unable to comply with the study requirements.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Active; 2 TAF/EVG (20/16mg) rectal inserts	Drug: TAF/EVG rectal insert; Phase 1: rectal inserts applied daily for 3 consecutive days Phase 2: rectal inserts applied every other day for 14 days
Placebo Comparator: Placebo; 2 Matching placebo inserts	Drug: Matching placebo rectal insert; Phase 1: rectal inserts applied daily for 3 consecutive days Phase 2: rectal inserts applied every other day for 14 days

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Frequency and intensity of Adverse Events	Safety measured by Grade 2 and higher adverse events (AEs)	from enrollment until Day 57 (after last rectal dose administration of study product)
Pharmacokinetics (PK) (maximum concentration (Cmax)) in blood	concentrations of TFV-DP and EVG	baseline and at 24, 48, and 72 hours after last rectal dose administration of study product in each Dosing Phase.
PK (Cmax) in rectal secretions	concentrations of TFV-DP and EVG	baseline and at 24, 48, and 72 hours after last rectal dose administration of study product in each Dosing Phase.
PK (Cmax) in rectal mucosal tissue	concentrations of TFV-DP and EVG	at 24 and 72 hours after last rectal dose administration of study product in each Dosing Phase.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
PK (Cmax) in cervicovaginal secretions	concentrations of TFV and EVG	at baseline and at 24, 48, and 72 hours after last rectal dose administration of study product in each Dosing Phase.
PK (Cmax) in cerviocovaginal mucosal tissues	concentrations TFV-DP and EVG	at 24 hours after last rectal dose administration of study product in each Dosing Phase.
Cytokine Profiles	To assess a change in cytokine profiles in rectal and vaginal secretions	at baseline and at 24, 48, and 72 hours after last rectal dose administration of study product in Dosing Phases 1 and 2
Microbiome Profiles	To assess a change to the microbiome composition in rectum and vagina	at baseline and at 24, 48, and 72 hours after last rectal dose administration of study product in Dosing Phases 1 and 2

Collaborators and Investigators

• Sponsor: Eastern Virginia Medical School
• Collaborators: Emory University; Centers for Disease Control and Prevention; CONRAD
• Investigators: Principal Investigator: Cassie Grimsley Ackerley, MD, MSc, Emory School Of Medicine; Study Chair: Richard E Haaland, Centers for Disease Control and Prevention; Study Chair: Gustavo F Doncel, MD, PhD, CONRAD

Study record dates

Study Major Dates

• Study Start (Actual): January 16, 2024
• Primary Completion (Estimated): October 31, 2024
• Study Completion (Estimated): December 31, 2024

Study Registration Dates

• First Submitted: January 31, 2024
• First Submitted That Met QC Criteria: February 15, 2024
• First Posted (Actual): February 23, 2024

Study Record Updates

• Last Update Posted (Actual): February 23, 2024
• Last Update Submitted That Met QC Criteria: February 15, 2024
• Last Verified: November 1, 2023

More Information

Terms related to this study

• Keywords: HIV; pre-exposure prophylaxis (PrEP); rectal insert
• Other Study ID Numbers: RITE Study

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No