Efavirenz Capsule Sprinkle and Liquid Formulations With Didanosine and Emtricitabine in HIV-1-infected Infants and Children 3 Months to 6 Years of Age: Study AI266-922. Issue 12 (December 2015)

• Record Type: Journal Article
• Authors: Pavia-Ruz, Noris; Rossouw, Magdel; Sáez-Llorens, Xavier; Bunupuradah, Torsak; Taylor, Mathew; Yang, Rong; Sevinsky, Heather; Krystal, Mark; Lataillade, Max; Seekins, Daniel; Biguenet, Sophie
• Is Part Of: Pediatric infectious disease journal. Volume 34:Issue 12(2015)
• Publication Date: 2015-12
• Subjects: pediatrics -- efavirenz -- pharmacokinetics -- safety -- efficacy; Communicable diseases in children -- Periodicals; Infection in children -- Periodicals; 618.929
• DOI: 10.1097/INF.0000000000000913
• Languages: English
• ISSNs: 0891-3668

Abstract

Abstract : Background: AI266-922 was an open-label, dose-ranging study that assessed the pharmacokinetics, safety and efficacy of efavirenz (EFV) in children (3 months to 6 years). Methods: Antiretroviral-naïve and antiretroviral-experienced HIV-1-infected children received once-daily EFV as oral solution or capsule sprinkle plus didanosine and emtricitabine (FTC). Pharmacokinetic analyses were undertaken at week 2 and repeated at weeks 10 and 18 after an EFV dose change or switch from oral solution to capsule sprinkle. Results: Thirty-seven subjects were treated. EFV area under the plasma concentration-time curve over 1 dosing interval from time 0 to 24 hours postdose values were generally suboptimal (<110 μM × h) in subjects younger than 3 years treated with oral solution; these subjects switched to capsule sprinkle. Twenty of 21 subjects younger than 3 years treated with capsule sprinkle achieved an EFV area under the plasma concentration-time curve over 1 dosing interval from time 0 to 24 hours postdose value >110 μM × h, although higher initial doses were administered in this age group. Interpatient variability in EFV exposure was high. By week 48, 77.8% and 63.0% of subjects achieved HIV-RNA <400 and <50 copies/mL, respectively. Median changes in log10 HIV-RNA and CD4 + percentage from baseline were −3.18 copies/mL and +6%, respectively. Two (5.4%) patients discontinued because of adverse events (AEs). Serious AEs occurred in 20 (54.1%) subjects. Common AEs were diarrhea (49%), nasopharyngitis (35%) and pneumonia (30%). Overall, 43% of subjects with suboptimal EFV exposure at week 2 developed resistance. Conclusions: Once-daily EFV, given as capsule sprinkle, achieved target exposures in this study although doses were 2–3 times higher than Food and Drug Administration–approved doses for children younger than 3 years. These data are useful for dose selection modeling and simulation; however, Food and Drug Administration–approved doses should be used clinically. EFV + didanosine + FTC was efficacious with no new pediatric safety findings reported. Abstract : Supplemental Digital Content is available in the text.