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Clinical Trial
. 2014 Nov-Dec;15(6):269-73.
doi: 10.1310/hct1506-269.

Cobicistat-boosted protease inhibitors in HIV-infected patients with mild to moderate renal impairment

Cheryl K McDonald  1 , Claudia Martorell  2 , Moti Ramgopal  3 , Francois Laplante  4 , Martin Fisher  5 , Frank A Post  6 , Yapei Liu  7 , Joanne Curley  7 , Michael E Abram  7 , Joseph Custodio  7 , Hiba Graham  7 , Martin S Rhee  7 , Javier Szwarcberg  7
Affiliations
Clinical Trial

Cobicistat-boosted protease inhibitors in HIV-infected patients with mild to moderate renal impairment

Cheryl K McDonald et al. HIV Clin Trials. 2014 Nov-Dec.

Abstract

Background: Cobicistat (COBI) is a pharmacoenhancer that optimizes systemic exposures of protease inhibitors (PIs) such as atazanavir (ATV) and darunavir (DRV).

Objective: To evaluate the efficacy and safety of switching ritonavir (RTV) to COBI in patients with creatinine clearance (CrCl) 50 to 89 mL/min who are virologically suppressed on a stable regimen containing ritonavir (RTV)-boosted ATV or DRV. Other components of the regimen remained unchanged.

Methods: A phase 3, non-comparative, open-label clinical trial.

Results: Seventy-three patients were enrolled. At week 48, 82% maintained virologic suppression. No emergent resistance developed. Serious adverse events (AEs) occurred in 7%, and study drug discontinuation due to AEs occurred in 10% (7 patients). There were 2 renal discontinuations and no cases of proximal renal tubulopathy. Small reductions in CrCl (median [IQR]) were observed as early as week 2, after which they were nonprogressive through week 48 (-3.8 [-9 to 0.8]). Changes in CrCl by baseline CrCl (< 70 vs ≥ 70) were -1.1 [-6.5 to 6.3] versus -6.6 [-12.4 to -0.7], respectively.

Conclusions: In HIV-1-infected patients with CrCl 50 to 89 mL/min switching from RTV to COBI, COBI-boosted PIs in combination with 2 nucleos(t)ide reverse transcriptase inhibitors were well-tolerated and effective in maintaining virologic suppression. The renal safety profile of COBI in this study was consistent with the long-term data in patients without renal impairment from the phase 3 studies of COBI-containing regimens.

Keywords: HIV clinical trials; cobicistat; renal impairment.

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