Rilpivirine pharmacokinetics without and with darunavir/ritonavir once daily in adolescents and young adults

Marc Foca, Ram Yogev, Andrew Wiznia, Rohan Hazra, Patrick Jean-Philippe, Bobbie Graham, Paula Britto, Vincent J. Carey, Jennifer King, Edward P. Acosta, Tim R. Cressey

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: Rilpivirine (RPV), a recently developed, once daily human immunodeficiency virus non-nucleoside reverse transcriptase inhibitor, is not currently approved for pediatric patients, but is sometimes prescribed for adolescents with multiple treatment failures, for regimen simplification or to minimize toxicity. Darunavir/ritonavir (DRV/r) administered once daily is also increasingly used in adolescents and may alter RPV pharmacokinetics (PK). We evaluated the PK interactions between RPV and DRV/r once daily in adolescents and young adults. Methods: Human immunodeficiency virus-infected subjects 12 to <24 years old receiving a stable background therapy including RPV 25 mg once daily without or combined with DRV/r 800/100 mg once daily were enrolled. Intensive 24-hour blood sampling was performed, and PK indices were determined using noncompartmental analysis. Protocol-defined target drug exposure ranges based on adult data were used to assess the adequacy of each regimen. Results: Fifteen subjects receiving RPV without and 14 subjects with DRV/r were enrolled. When dosed without DRV/r, the RPV geometric mean (90% confidence interval) for RPV AUC 0-24, C max and C 24 h were 2.38 μg h/mL (1.92-2.94), 0.14 μg/mL (0.12-0.18) and 0.07 μg/mL (0.03-0.10), respectively, similar to adult values. RPV concentrations were significantly increased with concomitant DRV/r use: RPV AUC 24, C max and C 24 h were 6.74 μg h/mL (4.89-9.28), 0.39 μg/mL (0.27-0.57) and 0.23 μg/mL (0.17-0.32), respectively, well above the target ranges based on adult data. DRV/r PK was not affected by coadministration of RPV. Conclusions: RPV PK in this adolescent population was similar to adults when dosed without DRV/r. DRV/r coadministration increased RPV exposure 2- to 3-fold, indicating that drug-related side effects should be closely monitored.

Original languageEnglish (US)
Pages (from-to)e271-e274
JournalPediatric Infectious Disease Journal
Volume35
Issue number9
DOIs
StatePublished - Sep 1 2016
Externally publishedYes

Keywords

  • adolescents
  • antiretrovirals
  • darunavir
  • pediatrics
  • rilpivirine

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Microbiology (medical)
  • Infectious Diseases

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