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HIV PreventionPhase 1NCT01575418

An Exploratory Rectal Safety Study of Three Tenofovir Gel Formulations

A Phase 1 study testing Rectal formulation (RF) of tenofovir 1% gel, Vaginal formulation (VF) of tenofovir 1% gel and Reduced glycerin vaginal formulation (RGVF) of tenofovir 1% gel in people with HIV Prevention, run by Ian McGowan at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This is a double-blinded, randomized, pharmacokinetic and safety study of 3 rectally applied tenofovir microbicide formulations: a vaginal formulation (VF), a reduced glycerin vaginal formulation (RGVF), and a rectal-specific formulation (RF). Nine HIV-negative men will be enrolled. Read more about this study

Who is it for?
Ages 18 years and older, men onlyHealthy volunteers can take part
Conditions the study is for
HIV Prevention
What is being tested?
Rectal formulation (RF) of tenofovir 1% gel, Vaginal formulation (VF) of tenofovir 1% gel and Reduced glycerin vaginal formulation (RGVF) of tenofovir 1% gel
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
9 participants
Where
1 siteUnited States
Study dates
Mar 2013to Nov 2013
Phase
Phase 1
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • Men only
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • ≥ Age of 18 at screening
  • Willing and able to communicate in English
  • Willing and able to provide written informed consent to take part in the study
  • Willing and able to provide adequate locator information
  • Understands and agrees to local STI reporting requirements
  • Biologically male
  • HIV-1 uninfected at screening according to the standard DAIDS algorithm 8. Willingness to provide semen sample on multiple occasions
  • 9. Per participant report at screening, a history of consensual RAI at least once within the six months prior to screening 10. Willingness to perform simulated RAI with CDS device 11. Willing to abstain from RAI or any practices which include rectal insertion of any product including those used during sexual intercourse (sex toys) for 48 hours before and after inpatient dosing and willing to refrain from ejaculation for a period of 48 hours prior to each semen collection 12. Must agree to use condoms for the duration of the study 13. Must be in general good health 14. Must agree not to participate in other drug trials 15. Availability to return for all study visits, barring unforeseen circumstances

Who cannot join

  • Significant colorectal symptom(s) as determined by medical history or by participant self-report (including but not limited to presence of any unresolved injury, infectious or inflammatory condition of the local mucosa, history of inflammatory bowel disease, presence of symptomatic external hemorrhoids, and presence of any painful anorectal conditions that would be tender to manipulation.)
  • At screening: participant-reported symptoms and/or clinical or laboratory diagnosis of active rectal or reproductive tract infection requiring treatment per current CDC guidelines or symptomatic urinary tract infection (UTI). Infections requiring treatment include Chlamydia (CT), gonorrhea (GC), syphilis, active HSV lesions, chancroid, genital sores or ulcers, and, if clinically indicated, genital warts. Note that HSV seropositivity with no active genital lesions is not an exclusion criterion, since treatment is not required. (Note: Allow one re-screening after documented treatment (30 days) in cases where urethral GC/CT identified at screening)
  • At screening:
  • Positive for hepatitis B surface antigen
  • Calculated creatinine clearance less than 60 mL/min by the Cockcroft-Gault formula where creatinine clearance in mL/min = (140 - age in years) x (weight in kg) x (1 for male)/72 x (serum creatinine in mg/dL)
  • Alanine transaminase (ALT) and/or aspartate aminotransferase (AST) > 2.5× the site laboratory ULN
Show all 13Show fewer
  • Known allergic reaction to methylparaben, propylparaben, sorbic acid, glycerin, glycerol, tenofovir, or other components of the test articles
  • Known HIV-infected partners
  • By participant report at enrollment, history of excessive daily alcohol use (as defined by the CDC as heavy drinking consisting of an average consumption of more than 2 drinks per day for men), frequent binge drinking or illicit drug use that includes any injection drugs, methamphetamines (crystal meth), heroin, or cocaine including crack cocaine, within the past 12 months
  • By participant report, use of any rectally-administered medications, rectally administered products containing N-9 (including condoms), any investigational products, and/or systemic immunomodulatory medications within the 4 weeks prior to the first inpatient visit and throughout study participation
  • History of recurrent urticaria
  • Participants whose whole body (EDE) radiation exposure, per the investigator's records and/or participant report, exceeds 5000mrem/year
  • Any other condition or prior therapy that, in the opinion of the investigator, would preclude informed consent, make study participation unsafe, make the individual unsuitable for the study or unable to comply with the study requirements. Such conditions may include, but are not limited to, current or recent history of severe, progressive, or uncontrolled substance abuse, or renal, hepatic, hematological, gastrointestinal, endocrine, pulmonary, neurological, or cerebral disease.

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Johns Hopkins University, Division of Clinical Pharmacology, Drug Development Unit

    Baltimore, Maryland, 21205

Other trials in United States

About this study

Official title: An Exploratory, Double-Blinded, Randomized, Pharmacokinetic and Safety Study of Three Rectally-Applied Tenofovir 1% Microbicide Gel Formulations

This is a double-blinded, randomized, pharmacokinetic and safety study of 3 rectally applied tenofovir microbicide formulations: a vaginal formulation (VF), a reduced glycerin vaginal formulation (RGVF), and a rectal-specific formulation (RF). Nine HIV-negative men will be enrolled.

Each participant will receive two inpatient doses of each radiolabeled study product. The first inpatient dose of each product will be administered without coital dynamics simulation (CDS), while the second inpatient dose will be followed by a CDS procedure at 1-hour post dose with instillation of radiolabeled autologous semen. There will be a washout period of at least 11 days between each dose.

Conditions
HIV Prevention
Being tested
Rectal formulation (RF) of tenofovir 1% gel, Vaginal formulation (VF) of tenofovir 1% gel, Reduced glycerin vaginal formulation (RGVF) of tenofovir 1% gel, Radiolabeling of study drugs and semen

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Rectal formulation (RF) of tenofovir 1% gelDrug

    The RF is translucent colorless viscous gel formulation containing 1% (w/w) of tenofovir (PMPA) formulated in purified water with EDTA, glycerin, methylparaben, propylparaben, carbopol, sodium carboxy methyl cellulose, and pH adjusted to 7. The RF is close to isoosmolar with an osmolality of 479 mOsmol/kg.

  • Vaginal formulation (VF) of tenofovir 1% gelDrug

    The original VF is a transparent, viscous gel formulation containing 1% (weight/ weight or w/w) of tenofovir (PMPA, 9-[(R)-2-(phosphonomethoxy)propyl]adenine monohydrate), formulated in purified water with edetate disodium, citric acid, glycerin, methylparaben, propylparaben, hydroxyethylcellulose, and pH adjusted to 4-5. This formulation has been used in all clinical trials (vaginal, penile, and rectal) of tenofovir 1% gel to date.

  • Reduced glycerin vaginal formulation (RGVF) of tenofovir 1% gelDrug

    Modified slightly from the original VF formulation, the RGVF has a lower glycerin content than the VF and a significantly reduced osmolality (836 or 846 versus 3111 mOsmol/kg). Lowering glycerin content lowered the viscosity, so the HEC concentration was increased by 10% (a change considered to be insignificant). The amount of parabens was increased by 10% each to improve the antimicrobical effectiveness. The RGVF formulation with 2.75% HEC was used in MTN-007 (CONRAD IND 73,382; currently enrolling), which is the only clinical study of this formulation. The RGVF formulation has since been modified to increase the viscosity.

  • Radiolabeling of study drugs and semenRadiation

    Study products (i.e. the gel formulations) will be radiolabeled with 111In-DTPA, an FDA-approved radiopharmaceutical commonly used in diagnostic nuclear medicine studies. The delivered dose per gel study product will be approximately 100 microCuries (µCi) to allow sufficient visualization for the imaging period.

    Autologous whole semen collected from the participants at designated visits will be radiolabeled with a delivered dose of approximately 500 microCuries (µCi) of 99mTc-sulfur colloid, also an FDA-approved radiopharmaceutical commonly used in diagnostic nuclear studies. The study team at JHU has extensive experience administering these radiopharmaceuticals rectally. Both of these radiopharmaceuticals will be prepared and delivered by a commercial radiopharmacy and mixed by the study investigators with the respective gel and whole semen vehicles.

    The study product and autologous whole semen will be loaded into calibrated syringes with luer lock adapter for dosing.

Study groups in NCT01575418
Study groupRoleWhat they receive
Rectal specific formulation (RF) stageExperimentalEach participant will receive two inpatient doses of each radiolabeled study product. The first inpatient dose of each product will be administered without coital dynamics simulation (CDS), while the second inpatient dose will be followed by a CDS procedure at 1-hour post dose with instillation of radiolabeled autologous semen. There will be a washout period of at least 11 days between each dose.
Receives: Drug: Rectal formulation (RF) of tenofovir 1% gel; Radiation: Radiolabeling of study drugs and semen
Vaginal formulation (VF) stageActive comparatorEach participant will receive two inpatient doses of each radiolabeled study product. The first inpatient dose of each product will be administered without coital dynamics simulation (CDS), while the second inpatient dose will be followed by a CDS procedure at 1-hour post dose with instillation of radiolabeled autologous semen. There will be a washout period of at least 11 days between each dose.
Receives: Drug: Vaginal formulation (VF) of tenofovir 1% gel; Radiation: Radiolabeling of study drugs and semen
Reduced glycerin vaginal formulation (RGVF) stageActive comparatorEach participant will receive two inpatient doses of each radiolabeled study product. The first inpatient dose of each product will be administered without coital dynamics simulation (CDS), while the second inpatient dose will be followed by a CDS procedure at 1-hour post dose with instillation of radiolabeled autologous semen. There will be a washout period of at least 11 days between each dose.
Receives: Drug: Reduced glycerin vaginal formulation (RGVF) of tenofovir 1% gel; Radiation: Radiolabeling of study drugs and semen

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Occurrence of adverse events and/or abnormal laboratory values Grade 2 or higher

    Grade 2 or higher clinical and laboratory adverse events as defined by the Division of AIDS Table for Grading the Severity of Adult and Pediatric Adverse Events, Version 1.0, Dec 2004 and Addendum 3 (Rectal Grading Tables for Use in Microbicide Studies) will be used to assess safety.

    Measured: Participants will be followed for the duration of study, an expected average of 12 weeks

Secondary outcomes (1)
  1. Area Under Curve (AUC)

    Pharmacokinetics (PK) measures will be evaluated as plasma tenofovir concentrations

    Distribution/migration of product and whole semen (with and without Coital Dynamic Simulation or CDS) will be evaluated based on:

    • Distribution of product radiolabel (111Indium DTPA) within the colonic lumen
    • Distribution of whole semen radiolabel (99mTc-sulfur colloid) within the colonic lumen

    And mucosal permeability (with and without CDS) will be measured via:

    • PK in blood of product radiolabel (111Indium DTPA)
    • Urine

    Measured: 0.25hr, 0.5hr, 0.75hr, 1hr, 1.25hr, 1.5hr, 1.75hr, 2hr, 2.33hr, 2.66hr, 3hr, 3.5hr, 4hr, 8hr, 16hr, and 24hr post-dose at Visits 2,4,5,7,8, and 10

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted11 Apr 2012 (estimated)
  2. Study startMar 2013
  3. Primary completionNov 2013
  4. Study completionNov 2013

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 1
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Crossover
Masking
Triple blind
Who is masked
Participant, Care provider, Investigator
Enrolment
9 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01575418
Sponsor's protocol ID
CHARM-02
Other IDs
5U19AI082637
Status last verified
May 2014
First submitted
1 Mar 2012
Last updated
8 May 2014
Results posted
No
Data monitoring committee
Yes

Publications

  • Hiruy H, Fuchs EJ, Marzinke MA, Bakshi RP, Breakey JC, Aung WS, Manohar M, Yue C, Caffo BS, Du Y, Abebe KZ, Spiegel HM, Rohan LC, McGowan I, Hendrix CW. A Phase 1 Randomized, Blinded Comparison of the Pharmacokinetics and Colonic Distribution of Three Candidate Rectal Microbicide Formulations of Tenofovir 1% Gel with Simulated Unprotected Sex (CHARM-02). AIDS Res Hum Retroviruses. 2015 Nov;31(11):1098-108. doi: 10.1089/AID.2015.0098. Epub 2015 Aug 24.

    PubMed 26227279

Questions about this trial

What is this clinical trial studying?

A Phase 1 study testing Rectal formulation (RF) of tenofovir 1% gel, Vaginal formulation (VF) of tenofovir 1% gel and Reduced glycerin vaginal formulation (RGVF) of tenofovir 1% gel in people with HIV Prevention, run by Ian McGowan at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 8 inclusion and 13 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 8 May 2014. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Occurrence of adverse events and/or abnormal laboratory values Grade 2 or higher (time frame: Participants will be followed for the duration of study, an expected average of 12 weeks). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01575418, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 8 May 2014.

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