Artemether/Lumefantrine and Nevirapine Interaction Study in HIV-infected Adults

This study has been completed.
Sponsor:
Collaborator:
London School of Hygiene and Tropical Medicine
Information provided by:
University of Cape Town
ClinicalTrials.gov Identifier:
NCT00790881
First received: November 13, 2008
Last updated: June 25, 2010
Last verified: June 2010
  Purpose

Despite the clinical significance of potential interactions between antimalarials and antiretrovirals, no drug interaction studies have been published and there is an urgent need to address this gap in current knowledge.

This study aims to assess the drug interaction between the antimalarial Artemether/Lumefantrine used for management of uncomplicated malaria and Nevirapine-based antiretroviral therapy.


Condition Intervention Phase
Malaria
HIV
Drug: Artemether/Lumefantrine
Drug: Artemether/ lumefantrine
Phase 4

Study Type: Interventional
Study Design: Endpoint Classification: Pharmacokinetics Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Pharmacokinetic Interaction Between the Antimalarial Combination Artemether/Lumefantrine and Combination Antiretroviral Therapy Including Nevirapine in HIV-infected Adults

Resource links provided by NLM:


Further study details as provided by University of Cape Town:

Primary Outcome Measures:
  • Lumefantrine plasma concentration [ Time Frame: day 7 ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Point estimates and 90% confidence intervals for the mean ratios of the lumefantrine, artemether and DHA log-transformed Cmax, AUC0-t, AUC0 ∞ , t½,z, tmax and MRT with/without NVP [ Time Frame: 21 days ] [ Designated as safety issue: Yes ]

Estimated Enrollment: 36
Study Start Date: October 2008
Study Completion Date: December 2009
Primary Completion Date: August 2009 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Antiretroviral-naive
Antiretroviral-naive included as control group
Drug: Artemether/Lumefantrine
Coartem (fixed dose Artemether20mg /Lumefantrine 120mg) Dose: 4 tablets(80mg/480mg) twice daily for 3 days at 0,8,24,36,48 and 60 hours
Other Name: Coartem
Active Comparator: Nevirapine-based antiretroviral therapy
Nevirapine-based antiretroviral therapy
Drug: Artemether/ lumefantrine
Coartem (fixed dose Artemether20mg /Lumefantrine 120mg) Dose: 4 tablets(80mg/480mg) twice daily for 3 days at 0,8,24,36,48 and 60 hours
Other Name: Coartem

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Informed and given ample time and opportunity to think about participation and willing and able to comprehend and comply with all trial requirements. The participant has given written informed consent to participate in the study and to abide by study restrictions.
  • Male or female subjects older than 18 years of age.
  • HIV-infected as documented by positive HIV-antibody test and confirmed by Western blot.
  • Body weight more than 35kg with a body mass index (BMI) ranging between 18.5 to 30kg/m2 inclusive (See Appendix 16.2).
  • Karnofsky score above 70 (See Appendix 16.5).
  • CD4 count ≥ 200 cells/mm3
  • Patients on NVP-based cART at stable doses without significant toxicity for at least 6 weeks at screening (Group 2 only).

Exclusion Criteria:

  • Patients diagnosed with Plasmodium falciparum malaria
  • Contraindications to artemether/lumefantrine:

    • Hypersensitivity to the artemether, lumefantrine or to any of the excipients of Coartem®.
    • Patients with severe malaria according to WHO definition.
    • Pregnant (as confirmed by an HCG test performed at screening) or breast-feeding female.
    • Patients with a family history of congenital prolongation of the QTc interval or sudden death or with any other clinical condition known to prolong the QTc interval such as patients with a history of symptomatic cardiac arrhythmias, with clinically relevant bradycardia or with severe cardiac disease.
    • Patients with known disturbances of electrolyte balance e.g. hypokalaemia or hypomagnesaemia.
    • Patients taking any drug which is metabolised by the cytochrome enzyme CYP2D6 (e.g. flecainide, metoprolol, imipramine, amitriptyline, clomipramine).
    • Patients taking drugs that are known to prolong the QTc interval such as antiarrhythmics of classes IA and III, neuroleptics, antidepressive agents, certain antibiotics including some agents of the following classes: macrolides, fluoroquinolones, imidazole, and triazole antifungal agents, certain non-sedating antihistaminics (terfenadine, astemizole), cisapride.
  • Contraindication to nevirapine:

    • Hypersensitivity to nevirapine or any of the excipients of Aspen Nevirapine®.
    • Severe hepatic dysfunction: Child-Pugh class B or C and in endstage renal failure in patients not on haemodialysis.
    • Aspartate transaminase (AST) or alanine aminotransferase (ALT) > 5 x upper limit of normal (ULN).
    • History of severe rash, rash accompanied by constitutional symptoms; hypersensitivity syndrome, or clinical hepatitis due to nevirapine.
  • Haemoglobin below 8.5g/dL for female and 9.5g/dL for male subjects.
  • Pharmacokinetic exclusion criteria:

    • Relevant history or current condition(s) that might interfere with drug absorption, distribution, metabolism or excretion.
    • Current smokers, or subjects who have stopped smoking less than 3 months prior to the date of screening.
    • History of or current substance abuse problem or a positive urine screen for drugs of abuse.
    • History of or current compulsive alcohol abuse problem.
    • The subject has consumed any alcohol, grapefruit or caffeine-containing products (ie tea, coffee, cola, chocolate) within 24 hours before the first dose of AL during each PK profile.
    • The subject has participated in strenuous exercise within 24 hours before the first IP administration.
  • General exclusion criteria:

    • Severely ill or suffering from any serious underlying disease (particularly cardiac, hepatic or renal disease) that in the opinion of the Investigator would make the participant unsuitable for the study in terms of their safety or study analysis.
    • The volunteer has participated in another study with any investigational product within 8 weeks before the first administration of the current investigational products, or until at least 5 x t½ elimination has lapsed, whichever is the greater.
    • Subjects who, in the opinion of the Investigator, should not participate in the study.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00790881

Locations
South Africa
Groote Schuur Hospital, Research ward
Cape Town, South Africa
Sponsors and Collaborators
University of Cape Town
London School of Hygiene and Tropical Medicine
Investigators
Principal Investigator: Karen Barnes, MD University of Cape Town
Study Director: Tamara Kredo, MD University of Cape Town
  More Information

No publications provided by University of Cape Town

Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: ACT Consortium, London School of Hygiene & Tropical Medicine
ClinicalTrials.gov Identifier: NCT00790881     History of Changes
Other Study ID Numbers: SEACAT 2.4.1, DOH-27-0807-2012
Study First Received: November 13, 2008
Last Updated: June 25, 2010
Health Authority: South Africa: Medicines Control Council
South Africa: National Health Research Ethics Council

Keywords provided by University of Cape Town:
malaria
HIV
AIDS
nevirapine
lumefantrine
artemether
drug interaction
pharmacokinetics

Additional relevant MeSH terms:
Malaria
Parasitic Diseases
Protozoan Infections
Artemether
Artemether-lumefantrine combination
Artemisinins
Lumefantrine
Nevirapine
Anthelmintics
Anti-HIV Agents
Anti-Infective Agents
Anti-Retroviral Agents
Antifungal Agents
Antimalarials
Antiparasitic Agents
Antiplatyhelmintic Agents
Antiprotozoal Agents
Antiviral Agents
Coccidiostats
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Nucleic Acid Synthesis Inhibitors
Pharmacologic Actions
Reverse Transcriptase Inhibitors
Schistosomicides
Therapeutic Uses

ClinicalTrials.gov processed this record on October 29, 2014