Comparison of Dapivirine Vaginal Gel and Film Formulation Pharmacokinetics and Pharmacodynamics (FAME 02B).
While preexposure prophylaxis with oral tenofovir/emtricitabine reduces HIV acquisition rates, poor adherence to and acceptability of vaginal gels and the potential for evolving drug resistance have led to development of vaginal film formulations and other antiretroviral drugs, respectively, including the non-nucleoside reverse transcriptase inhibitor dapivirine. In this two-arm crossover study of a novel fast-dissolving dapivirine film and a previously studied semisolid dapivirine gel, 10 healthy women received a single 1.25 mg vaginal dose of each study product; one withdrew after the first dose. Clinical, pharmacokinetic, and antiviral pharmacodynamic assessments (ex vivo HIV-BaL challenge of tissue explants) were performed over 168 h postdose. Six of ten participants experienced mild to moderate adverse effects, similar between products, with no severe adverse events or adverse events attributed to study products. There were no statistically significant differences in plasma, cervicovaginal fluid (CVF), or cervical tissue dapivirine concentrations between the gel and film (all p > .05). CVF dapivirine concentrations were 1.5 and 6 log10greater than tissue and plasma concentrations, respectively (p < .001). Both film and gel demonstrated reduced cervical tissue infectivity after ex vivo HIV challenge 5 h postdose, compared to baseline and 72-h postdose biopsies (p < .05 for gel, p = .06 for film). There was no difference in ex vivo explant HIV challenge between gel and film. The dapivirine film and gel performed similarly in terms of tolerability, pharmacokinetics, and antiviral effect. Dapivirine film may provide an alternative to pharmacokinetically comparable dapivirine gel formulations. Effectiveness remains to be tested.
1 Department of Gynecology and Obstetrics, Johns Hopkins University , Baltimore, Maryland.
Jennifer A
JA
Robinson
2 Department of Pathology, Johns Hopkins University , Baltimore, Maryland.
Mark A
MA
Marzinke
3 Department of Medicine (Clinical Pharmacology), Johns Hopkins University , Baltimore, Maryland.
Rahul P
RP
Bakshi
3 Department of Medicine (Clinical Pharmacology), Johns Hopkins University , Baltimore, Maryland.
Edward J
EJ
Fuchs
3 Department of Medicine (Clinical Pharmacology), Johns Hopkins University , Baltimore, Maryland.
Christine L
CL
Radebaugh
3 Department of Medicine (Clinical Pharmacology), Johns Hopkins University , Baltimore, Maryland.
Wutyi
W
Aung
4 HJF-DAIDS, a Division of the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Contractor to National Institute of Allergy and Infectious Diseases, National Institutes of Health , Department of Health and Human Services, Bethesda, Maryland.
Hans M L
HM
Spiegel
1 Department of Gynecology and Obstetrics, Johns Hopkins University , Baltimore, Maryland.
Jenell S
JS
Coleman
5 Department of Pharmaceutical Sciences, University of Pittsburgh , Pittsburgh, Pennsylvania.|6 Magee-Womens Research Institute , Pittsburgh, Pennsylvania.
Lisa C
LC
Rohan
3 Department of Medicine (Clinical Pharmacology), Johns Hopkins University , Baltimore, Maryland.
Craig W
CW
Hendrix
D000282:Administration, Intravaginal; D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics*; D002584:Cervix Uteri / Q000737:chemistry; D018592:Cross-Over Studies; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology; D005260:Female; D006801:Humans; D008875:Middle Aged; D010949:Plasma / Q000737:chemistry; D011743:Pyrimidines / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics*; D013997:Time Factors; D014622:Vaginal Creams, Foams, and Jellies / Q000008:administration & dosage / Q000493:pharmacokinetics; D055815:Young Adult
D019380:Anti-HIV Agents; D011743:Pyrimidines; D014622:Vaginal Creams, Foams, and Jellies; C481671:Dapivirine
HIV; dapivirine; pharmacodynamics; pharmacokinetics; preexposure prophylaxis; vaginal film; vaginal gel