Efficacy, Safety, and Pharmacokinetics by Body Mass Index Category in Phase 3/3b Long-Acting Cabotegravir Plus Rilpivirine Trials.

BACKGROUND: Cabotegravir plus rilpivirine (CAB + RPV) is a guideline-recommended long-acting (LA) injectable regimen for the maintenance of human immunodeficiency virus-1 (HIV-1) virologic suppression. This post hoc analysis summarizes CAB + RPV LA results by baseline body mass index (BMI) category among phase 3/3b trial participants. METHODS: Data from CAB + RPV-naive participants receiving every 4 or 8 week dosing in FLAIR, ATLAS, and ATLAS-2M were pooled through week 48. Data beyond week 48 were summarized by study (FLAIR through week 96 and ATLAS-2M through week 152). HIV-1 RNA <50 and ≥50 copies/mL, confirmed virologic failure (CVF; 2 consecutive HIV-1 RNA ≥200 copies/mL), safety and tolerability, and plasma CAB and RPV trough concentrations were evaluated by baseline BMI (<30 kg/m2, lower; ≥30 kg/m2, higher). RESULTS: Among 1245 CAB + RPV LA participants, 213 (17%) had a baseline BMI ≥30 kg/m2. At week 48, 92% versus 93% of participants with lower versus higher BMI had HIV-1 RNA <50 copies/mL, respectively. Including data beyond week 48, 18 participants had CVF; those in the higher BMI group (n = 8) all had at least 1 other baseline factor associated with CVF (archived RPV resistance-associated mutations or HIV-1 subtype A6/A1). Safety and pharmacokinetic profiles were comparable between BMI categories. CONCLUSIONS: CAB + RPV LA was efficacious and well tolerated, regardless of baseline BMI category. CLINICAL TRIALS REGISTRATION: NCT02938520, NCT02951052, and NCT03299049.

Elasticity of the porcine lens capsule as measured by osmotic swelling.

As an alternative to purely mechanical methods, optical tracking of passive osmotic swelling was used to assess mechanical properties of the porcine lens capsule. A simple model was developed accounting for the permeability of the lens fiber cells and capsule to water, the concentration of fixed charges in the fiber cells, and the capsule's resistance to the swelling of fiber cells. Fitting the model solution to experimental data provided an estimate of the elastic modulus of the lens capsule under the assumption of linear isotropic elasticity. The calculated elastic modulus at a fixed charge density of 20 mol m(-3) was 2.0+/-0.5 MPa (mean+/-95% confidence interval; n=15) for 0.1% saline solution, 0.64+/-0.3 MPa (n=10) for 0.2% saline solution, and 0.28+/-0.5 MPa (n=6) for 0.5% saline solution. These values are comparable to previously reported moduli of elasticity for the porcine lens capsule at small strains (<10%), and the slight increase with hypotonicity is consistent with the nonlinear mechanical behavior of the lens capsule. Although limited by being a single measurement on a heterogeneous tissue, osmotic swelling provides a quantitative assessment of the stiffness of the lens capsule without requiring dissection or manipulation of the lens. Thus, the new method could be useful for small animal models.

Ex vivo porcine iris stiffening due to drug stimulation.

The purpose of this study was to quantify how the elastic modulus of the ex vivo iris changes following stimulation by pilocarpine (PILO), phenylephrine (PE), and tropicamide (TROP). Irides (n = 20) were dissected from porcine eyes within 4 h post-mortem and tested uniaxially. Either the entire iris or sector thereof was used. The samples were stretched up to 40% Green strain. The radial modulus was calculated from the linear portion of the stress-strain curve, and the azimuthal modulus was fitted to a model treating the iris as a collection of circular elastic bands. One of the three drugs (n = 6 or 7) of interest was added (80 microg/ml) to the bath surrounding the tissue, and the test was repeated. Changes in pupil diameter of free-floating samples and isometric force of mounted samples confirmed that the tissue was responsive to the drugs. The untreated iris modulus for cut sections in radial extension was 4.0 +/- 0.9 kPa (mean +/- s.d., n = 20), and treated iris modulus was 7.7 +/- 2.0 kPa (PILO, n = 7), 6.9 +/- 2.2 kPa (PE, n = 6), and 8.4 +/- 1.7 kPa (TROP, n = 7). Intact irides (n = 10) gave similar trends but values approximately 25% higher, presumably due to support from the nominally unloaded tissue. The azimuthal modulus of the untreated iris was 2.97 +/- 1.3 kPa (n = 5), and that of the treated iris (PILO) was 5.34 +/- 2.1 kPa. Although PILO, PE, and TROP work by different mechanisms, all three had similar results - an increase of modulus by a factor of two. These results suggest that in most normal situations the iris remains compliant at all pupil diameters.