The design and implementation of A5146, a prospective trial assessing the utility of therapeutic drug monitoring using an inhibitory quotient in antiretroviral-experienced HIV-infected patients.

TitleThe design and implementation of A5146, a prospective trial assessing the utility of therapeutic drug monitoring using an inhibitory quotient in antiretroviral-experienced HIV-infected patients.
Publication TypeJournal Article
Year of Publication2008
AuthorsDemeter LM, A Mukherjee L, DiFrancesco R, Jiang H, DiCenzo R, Bastow B, Rinehart AR, Morse GD, Albrecht M
JournalHIV Clin Trials
Volume9
Issue1
Pagination61-72
Date Published2008 Jan-Feb
ISSN1528-4336
KeywordsAnti-HIV Agents, Drug Monitoring, HIV, HIV Infections, HIV Protease Inhibitors, Humans, Research Design
Abstract

The AIDS Clinical Trials Group designed and implemented a prospective, randomized, strategy trial in antiretroviral-experienced, HIV-infected patients to evaluate the virologic impact of protease inhibitor dose escalation in response to therapeutic drug monitoring (TDM) with an inhibitory quotient, which integrates both drug exposure and viral drug resistance. In the process of developing this clinical trial, several unique challenges were identified that required innovative solutions. The major challenge was the need to integrate resistance testing, pharmacokinetic data, medication adherence, toxicity data, clinical assessments, randomization assignment, and protocol-specified clinical management in a way that could be utilized in real time by the protocol team, communicated promptly to the clinical sites, and transmitted accurately to the study database. In addition, the protocol team had to address the relative lack of commercially available TDM laboratories in the United States that were experienced in antiretroviral drug assays and a lack of familiarity with the principles of pharmacokinetic monitoring at participating clinical sites. This article outlines the rationale for the design of this strategy trial, specific barriers to implementation that were identified, and solutions that were developed with the hope that these experiences will facilitate the design and conduct of future trials of TDM.

DOI10.1310/hct0901-61
Alternate JournalHIV Clin Trials
PubMed ID18215983
PubMed Central IDPMC2821072
Grant ListM01-RR00044 / RR / NCRR NIH HHS / United States
N01-AI-38858 / AI / NIAID NIH HHS / United States
N01-AI-68636 / AI / NIAID NIH HHS / United States
U01 AI-068634 / AI / NIAID NIH HHS / United States
U01 AI-069472 / AI / NIAID NIH HHS / United States
U01 AI-38855 / AI / NIAID NIH HHS / United States
U01 AI069511 / AI / NIAID NIH HHS / United States
U01 AI069511-04 / AI / NIAID NIH HHS / United States
U01-AI-069511 / AI / NIAID NIH HHS / United States
UM1 AI069511 / AI / NIAID NIH HHS / United States