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| Title: | Steady state bioequivalence of generic and innovator formulations of Stavudine, Lamivudine, and Nevirapine in HIV-infected Ugandan adults. |
| Authors: | Byakika-Tusiime, Jayne
Chinn, Leslie W.
Oyugi, Jessica H.
Obua, Celestino
Bangsberg, David R
Kroetz, Deanna L. |
| Keywords: | Antiretroviral therapy
HIV/AIDS
Adherence
Uganda
ARVs |
| Issue Date: | 2008 |
| Publisher: | Public Library of Science |
| Citation: | Byakika-Tusiime, J., Chinn, L.W., Oyugi, J.H., Obua, C., Bangsberg, D.R., Kroetz, D.L. (2008). Steady state bioequivalence of generic and innovator formulations of Stavudine, Lamivudine, and Nevirapine in HIV-infected Ugandan adults. PLoS ONE 3(12) |
| Abstract: | Background: Generic antiretroviral therapy is the mainstay of HIV treatment in resource-limited settings, yet there is little
evidence confirming the bioequivalence of generic and brand name formulations. We compared the steady-state
pharmacokinetics of lamivudine, stavudine and nevirapine in HIV-infected subjects who were receiving a generic
formulation (TriomuneH) or the corresponding brand formulations (EpivirH, ZeritH, and ViramuneH).
Methodology/Principal Findings: An open-label, randomized, crossover study was carried out in 18 HIV-infected Ugandan
subjects stabilized on Triomune-40. Subjects received lamivudine (150 mg), stavudine (40 mg), and nevirapine (200 mg) in
either the generic or brand formulation twice a day for 30 days, before switching to the other formulation. At the end of
each treatment period, blood samples were collected over 12 h for pharmacokinetic analysis. The main outcome measures
were the mean AUC0–12h and Cmax. Bioequivalence was defined as a geometric mean ratio between the generic and brand
name within the 90% confidence interval of 0.8–1.25. The geometric mean ratios and the 90% confidence intervals were:
stavudine Cmax, 1.3 (0.99–1.71) and AUC0–12h, 1.1 (0.87–1.38); lamivudine Cmax, 0.8 (0.63–0.98) and AUC0–12h, 0.8 (0.65–0.99);
and nevirapine Cmax, 1.1 (0.95–1.23) and AUC0–12h, 1.1 (0.95–1.31). The generic formulation was not statistically
bioequivalent to the brand formulations during steady state, although exposures were comparable. A mixed random effects
model identified about 50% intersubject variability in the pharmacokinetic parameters.
Conclusions/Significant Findings: These findings provide support for the use of Triomune in resource-limited settings,
although identification of the sources of intersubject variability in these populations is critical. |
| URI: | doi:10.1371/journal.pone.0003981
http://hdl.handle.net/123456789/1920 |
| ISSN: | 1932-6203 |
| Appears in Collections: | Research Articles (Health-Sciences)
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| Byakika-Tusiime-chs-res.pdf | | 146Kb | Adobe PDF | View/Open |
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