Pharmacokinetics, safety and efficacy of darunavir/ritonavir in treatment-experienced children and adolescents

Authors:
  • RBRosa Bologna
    Rosa Bologna
  • PCPedro Cahn
    Pedro Cahn
  • SRSorin Rugina
    Sorin Rugina
  • PFPatricia Flynn
    Patricia Flynn
  • CFClaudia Fortuny
    Claudia Fortuny
  • PVPeter Vis
    Peter Vis
  • VSVanitha Sekar
    Vanitha Sekar
  • BBBen van Baelen
    Ben van Baelen
  • IDInge Dierynck
    Inge Dierynck
  • SSSabrina Spinosa-Guzman
    Sabrina Spinosa-Guzman
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Abstract
To assess pharmacokinetics, safety and efficacy of darunavir/ritonavir (DRV/r) and optimized background regimen in treatment-experienced patients (6-17 years).Forty-eight-week, open-label, two-part, phase II study.In part I, 44 patients were randomized (1: 1 ratio) to receive a body weight-adjusted, adult-equivalent dose (group A) or a 20-33% higher DRV/r twice daily (b.i.d.) dose (group B). Pharmacokinetics, safety and efficacy were assessed following 2-week dosing (part I), which determined dosing for part II (evaluated 48-week safety and efficacy).In part I, both groups met the protocol-specified criteria for pharmacokinetics and showed favorable tolerability and efficacy. The following body-weight doses were selected: DRV/r 375/50 mg b.i.d. (20- or =40 kg); these gave an AUC24h, C0h and Cmax of 102, 114 and 112%, respectively, versus the corresponding mean adult pharmacokinetic parameter. In part II, 80 patients received DRV/r (median age: 14 years, mean baseline HIV-1 RNA: 4.64 log(10)copies/ml). One patient (1%) discontinued (treatment-unrelated grade 3 anxiety). An abnormal mean baseline triglyceride level was normalized at 48 weeks (P < 0.01). At week 48, 65% had at least 1.0 log(10)HIV-1 RNA reduction; 59 and 48% achieved HIV-1 RNA less than 400 and less than 50 copies/ml, respectively (time-to-loss-of-virologic response). Mean age-adjusted weight z-score increased by 0.2 (P = 0.003).In treatment-experienced children and adolescents, DRV/r showed comparable exposure to adults with appropriate dose selection, favorable safety and tolerability, improved body weight and significant virologic response. DRV/r is a valuable therapeutic option for this population.

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