Phase 1 Safety and Pharmacokinetics Study of MK-2048/Vicriviroc (MK-4176)/MK-2048A Intravaginal Rings

Abstract

Background: Vaginal rings (VR) containing antiretroviral (ARV) drugs can be utilized for prevention of human immunodeficiency virus (HIV) with potential for improved adherence compared to daily pills. Combination ARV VRs could improve efficacy.

Methods: MTN-027, a single-blind, randomized, placebo-controlled trial in 48 women, evaluated VRs containing MK-2048 (30 mg) and vicriviroc (VCV, 182 mg), alone or in combination, and placebo used continuously for 28 days. Safety was assessed by recording adverse events. Drug concentrations were quantified in plasma, vaginal fluid, cervical tissue, and rectal fluid. Cervical tissue was utilized for ex vivo HIV inhibition analysis.

Results: There was no difference in related genitourinary adverse events between treatment arms compared to placebo. VCV and MK-2048 released from single or combination VRs both achieved peak concentrations in vaginal fluids, which were substantially higher compared to plasma (200× for VCV, 30× for MK-2048) and rectal fluid. In an ex vivo challenge assay, the antiviral activity of VCV and/or MK-2048 was not correlated with tissue-associated drug concentrations. Most women (77%) were fully adherent to 28 days of continuous VR use and found the VR acceptable.

Conclusions: VCV and/or MK-2048 containing VRs were safe and acceptable. Both VCV and MK-2048 were quantifiable in all matrixes tested with peak compartmental drug concentrations similar for single and combination drug VRs. Tissue-associated VCV and/or MK-2048 did not correlate with inhibition of HIV infection. These data highlight the need to assess adequacy of drug dosing in the VR and measuring genital tissue drug concentrations to develop more precise concentration-response relationships.

Trial registration: ClinicalTrials.gov NCT02356302.

Keywords: HIV prevention; MK-2048; intravaginal ring; microbicide; vicriviroc.

© The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

Figures

Figure 1.

Flowchart of participants.

Figure 2.

Median VCV and MK-2048 plasma and vaginal fluid concentrations over time. A, plasma VCV concentrations. B, vaginal fluid VCV concentrations. C, plasma MK-2048 concentrations. D, vaginal fluid MK-2048 concentrations. Abbreviation: VCV, vicriviroc.

Figure 3.

VCV and MK-2048 related HIV inhibition in cervical tissue, vaginal fluid, and plasma. Abbreviations: HIV, human immunodeficiency virus; VCV, vicriviroc.

Figure 4.

Remnant VCV and MK-2048 concentrations in used vaginal rings. Abbreviation: VCV, vicriviroc.