title: Effect of fosamprenavir-ritonavir on the pharmacokinetics of dolutegravir in healthy subjects.
abstract: Dolutegravir (DTG) is an HIV integrase inhibitor (INI) with demonstrated activity in INI-naive and INI-resistant patients. The objective of this open-label, 2-period, single-sequence study was to evaluate the effect of fosamprenavir-ritonavir (FPV-RTV) on the steady-state plasma pharmacokinetics of DTG. Twelve healthy subjects received 50 mg DTG once daily for 5 days (period 1), followed by 10 days of 50 mg DTG once daily in combination with 700/100 mg FPV-RTV every 12 h (period 2). All doses were administered in the fasting state. Serial pharmacokinetic samples for DTG and amprenavir and safety assessments were obtained throughout the study. Noncompartmental pharmacokinetic analysis was performed, and geometric least-squares mean ratios and 90% confidence intervals were generated for within-subject treatment comparison. Fosamprenavir-ritonavir decreased the DTG area under the concentration-time curve, maximum concentration in plasma, and concentration in plasma at the end of the dosing interval by 35%, 24%, and 49%, respectively. Both DTG and DTG with FPV-RTV were well tolerated; no subject withdrew because of adverse events. The most frequently reported drug-related adverse events were rash, abnormal dreams, and nasopharyngitis. The modest decrease in DTG exposure when it was coadministered with FPV-RTV is not considered clinically significant, and DTG dose adjustment is not required with coadministration of FPV-RTV in INI-naive patient populations on the basis of established "no-effect" boundaries of DTG. In the INI-resistant population, as a cautionary measure, alternative combinations that do not include FPV-RTV should be considered. (This study has been registered at ClinicalTrials.gov under identifier NCT01209065.).
authors.affiliation: GlaxoSmithKline, Research Triangle Park, North Carolina, USA ivy.h.song@gsk.com.
authors.forename: Ivy
authors.initials: I
authors.lastname: Song
authors.affiliation: GlaxoSmithKline, Research Triangle Park, North Carolina, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Borland
authors.affiliation: GlaxoSmithKline, Research Triangle Park, North Carolina, USA.
authors.forename: Shuguang
authors.initials: S
authors.lastname: Chen
authors.affiliation: GlaxoSmithKline, Research Triangle Park, North Carolina, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Peppercorn
authors.affiliation: Shionogi Co., Ltd., Osaka, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Wajima
authors.affiliation: GlaxoSmithKline, Research Triangle Park, North Carolina, USA.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Piscitelli
mesh_terms: D000328:Adult; D019540:Area Under Curve; D002219:Carbamates / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology*; D004334:Drug Administration Schedule; D004347:Drug Interactions; D005260:Female; D005663:Furans; D019427:HIV Integrase / Q000187:drug effects; D019428:HIV Integrase Inhibitors / Q000493:pharmacokinetics*; D017320:HIV Protease Inhibitors / Q000493:pharmacokinetics; D064368:Healthy Volunteers; D006575:Heterocyclic Compounds, 3-Ring / Q000097:blood / Q000493:pharmacokinetics*; D006801:Humans; D008297:Male; D010755:Organophosphates / Q000009:adverse effects / Q000494:pharmacology*; D010078:Oxazines; D010879:Piperazines; D011728:Pyridones; D019438:Ritonavir / Q000009:adverse effects / Q000494:pharmacology*; D013449:Sulfonamides / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology*; D000099226:Dolutegravir
chemical_list: D002219:Carbamates; D005663:Furans; D019427:HIV Integrase; D019428:HIV Integrase Inhibitors; D017320:HIV Protease Inhibitors; D006575:Heterocyclic Compounds, 3-Ring; D010755:Organophosphates; D010078:Oxazines; D010879:Piperazines; D011728:Pyridones; D019438:Ritonavir; D013449:Sulfonamides; D000099226:Dolutegravir; C095108:amprenavir; C426859:fosamprenavir