Competing drug-drug interactions among multidrug antiretroviral regimens used in the treatment of HIV-infected subjects: ACTG 884

Courtney V. Fletcher, Edward P. Acosta, Hailong Cheng, Richard Haubrich, Margaret Fischl, Ralph Raasch, Charlotte Mills, X. Joan Hu, David Katzenstein, Rory P. Remmel, Roy M. Gulick

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Objective: To evaluate the steady state concentrations of saquinavir, ritonavir, nelfinavir, delavirdine, and adefovir in six different three- and four-drug combination regimens. Design: Randomized, partially double-blinded, multicenter study in a population of indinavir-experienced subjects with virologic failure. The first seven subjects enrolled in each of the six treatment arms from 10 participating sites were entered into this pharmacokinetic evaluation. Setting: Multicenter study of the AIDS Clinical Trials Group (ACTG). Patients: HIV-infected subjects. Interventions: A 12-hour pharmacokinetic study was conducted after 2 weeks of drug administration. Main outcome measures: Area under the concentration - Time curve with statistical comparisons to evaluate the effect of the second protease inhibitor and the effect of the non-protease inhibitors. Results: There was no difference in saquinavir concentrations according to whether the second protease inhibitor was ritonavir or nelfinavir. Saquinavir concentrations in the groups receiving the combination of delavirdine plus adefovir dipivoxil were reduced by approximately 50% compared with those receiving delavirdine. Delavirdine concentrations were reduced by approximately 50%, in the delavirdine plus adefovir dipivoxil arms compared with the delavirdine arms. Conclusions: Saquinavir concentrations were significantly lower in the arms containing the combination of delavirdine and adefovir dipivoxil compared with the arms containing delavirdine. Delavirdine concentrations were significantly lower when coadministered with adefovir dipivoxil. These drug-drug interactions were not expected, the mechanism(s) is (are) not clear, and additional studies are warranted. This study illustrates the need to understand more fully the pharmacokinetic characteristics of complex combination antiretroviral regimens prior to use in patient management. (C) 2000 Lippincott Williams and Wilkins.

Original languageEnglish (US)
Pages (from-to)2495-2501
Number of pages7
JournalAIDS
Volume14
Issue number16
DOIs
StatePublished - Nov 27 2000

Fingerprint

Delavirdine
Drug Interactions
Acquired Immunodeficiency Syndrome
Clinical Trials
HIV
Saquinavir
Pharmaceutical Preparations
Nelfinavir
Ritonavir
Therapeutics
Pharmacokinetics
Protease Inhibitors
Multicenter Studies
Indinavir
compound A 12
Drug Combinations

Keywords

  • Antiretroviral drugs
  • Drug-drug interactions
  • Pharmacokinetics

Cite this

Fletcher, C. V., Acosta, E. P., Cheng, H., Haubrich, R., Fischl, M., Raasch, R., ... Gulick, R. M. (2000). Competing drug-drug interactions among multidrug antiretroviral regimens used in the treatment of HIV-infected subjects: ACTG 884. AIDS, 14(16), 2495-2501. https://doi.org/10.1097/00002030-200011100-00011

Competing drug-drug interactions among multidrug antiretroviral regimens used in the treatment of HIV-infected subjects : ACTG 884. / Fletcher, Courtney V.; Acosta, Edward P.; Cheng, Hailong; Haubrich, Richard; Fischl, Margaret; Raasch, Ralph; Mills, Charlotte; Hu, X. Joan; Katzenstein, David; Remmel, Rory P.; Gulick, Roy M.

In: AIDS, Vol. 14, No. 16, 27.11.2000, p. 2495-2501.

Research output: Contribution to journalArticle

Fletcher, CV, Acosta, EP, Cheng, H, Haubrich, R, Fischl, M, Raasch, R, Mills, C, Hu, XJ, Katzenstein, D, Remmel, RP & Gulick, RM 2000, 'Competing drug-drug interactions among multidrug antiretroviral regimens used in the treatment of HIV-infected subjects: ACTG 884', AIDS, vol. 14, no. 16, pp. 2495-2501. https://doi.org/10.1097/00002030-200011100-00011
Fletcher, Courtney V. ; Acosta, Edward P. ; Cheng, Hailong ; Haubrich, Richard ; Fischl, Margaret ; Raasch, Ralph ; Mills, Charlotte ; Hu, X. Joan ; Katzenstein, David ; Remmel, Rory P. ; Gulick, Roy M. / Competing drug-drug interactions among multidrug antiretroviral regimens used in the treatment of HIV-infected subjects : ACTG 884. In: AIDS. 2000 ; Vol. 14, No. 16. pp. 2495-2501.
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abstract = "Objective: To evaluate the steady state concentrations of saquinavir, ritonavir, nelfinavir, delavirdine, and adefovir in six different three- and four-drug combination regimens. Design: Randomized, partially double-blinded, multicenter study in a population of indinavir-experienced subjects with virologic failure. The first seven subjects enrolled in each of the six treatment arms from 10 participating sites were entered into this pharmacokinetic evaluation. Setting: Multicenter study of the AIDS Clinical Trials Group (ACTG). Patients: HIV-infected subjects. Interventions: A 12-hour pharmacokinetic study was conducted after 2 weeks of drug administration. Main outcome measures: Area under the concentration - Time curve with statistical comparisons to evaluate the effect of the second protease inhibitor and the effect of the non-protease inhibitors. Results: There was no difference in saquinavir concentrations according to whether the second protease inhibitor was ritonavir or nelfinavir. Saquinavir concentrations in the groups receiving the combination of delavirdine plus adefovir dipivoxil were reduced by approximately 50{\%} compared with those receiving delavirdine. Delavirdine concentrations were reduced by approximately 50{\%}, in the delavirdine plus adefovir dipivoxil arms compared with the delavirdine arms. Conclusions: Saquinavir concentrations were significantly lower in the arms containing the combination of delavirdine and adefovir dipivoxil compared with the arms containing delavirdine. Delavirdine concentrations were significantly lower when coadministered with adefovir dipivoxil. These drug-drug interactions were not expected, the mechanism(s) is (are) not clear, and additional studies are warranted. This study illustrates the need to understand more fully the pharmacokinetic characteristics of complex combination antiretroviral regimens prior to use in patient management. (C) 2000 Lippincott Williams and Wilkins.",
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AU - Acosta, Edward P.

AU - Cheng, Hailong

AU - Haubrich, Richard

AU - Fischl, Margaret

AU - Raasch, Ralph

AU - Mills, Charlotte

AU - Hu, X. Joan

AU - Katzenstein, David

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N2 - Objective: To evaluate the steady state concentrations of saquinavir, ritonavir, nelfinavir, delavirdine, and adefovir in six different three- and four-drug combination regimens. Design: Randomized, partially double-blinded, multicenter study in a population of indinavir-experienced subjects with virologic failure. The first seven subjects enrolled in each of the six treatment arms from 10 participating sites were entered into this pharmacokinetic evaluation. Setting: Multicenter study of the AIDS Clinical Trials Group (ACTG). Patients: HIV-infected subjects. Interventions: A 12-hour pharmacokinetic study was conducted after 2 weeks of drug administration. Main outcome measures: Area under the concentration - Time curve with statistical comparisons to evaluate the effect of the second protease inhibitor and the effect of the non-protease inhibitors. Results: There was no difference in saquinavir concentrations according to whether the second protease inhibitor was ritonavir or nelfinavir. Saquinavir concentrations in the groups receiving the combination of delavirdine plus adefovir dipivoxil were reduced by approximately 50% compared with those receiving delavirdine. Delavirdine concentrations were reduced by approximately 50%, in the delavirdine plus adefovir dipivoxil arms compared with the delavirdine arms. Conclusions: Saquinavir concentrations were significantly lower in the arms containing the combination of delavirdine and adefovir dipivoxil compared with the arms containing delavirdine. Delavirdine concentrations were significantly lower when coadministered with adefovir dipivoxil. These drug-drug interactions were not expected, the mechanism(s) is (are) not clear, and additional studies are warranted. This study illustrates the need to understand more fully the pharmacokinetic characteristics of complex combination antiretroviral regimens prior to use in patient management. (C) 2000 Lippincott Williams and Wilkins.

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