Transdermal administration remains an active research and development area as an alternative route for long-acting drug delivery. It avoids major drawbacks of conventional oral (gastrointestinal side effects, low drug bioavailability, and need for multiple dosing) or parenteral routes (invasiveness, pain, and psychological stress and bio-hazardous waste generated from needles), thereby increasing patient appeal and compliance. This review focuses on the current state of long-acting transdermal drug delivery, including adhesive patches, microneedles, and molecularly imprinted polymeric systems. Each subsection describes an approach including key considerations in formulation development, design, and process parameters with schematics. An overview of commercially available conventional (adhesive) patches for long-acting drug delivery (longer than 24 h), the reservoir- and matrix-type systems under preclinical evaluation, as well as the advanced transdermal formulations, such as the core-shell, nanoformulations-incorporated and stimuli-responsive microneedles, and 3D-printed and molecularly imprinted polymers that are in development, is also provided. Finally, we elaborated on translational aspects, challenges in patch formulation development, and future directions for the clinical advancement of new long-acting transdermal products.
Background On-demand topical products could be an important tool for human immunodeficiency virus (HIV) prevention. We evaluated the safety, pharmacokinetics, and ex vivo pharmacodynamics of a tenofovir alafenamide/elvitegravir (TAF/EVG, 20 mg/16 mg) insert administered rectally. Methods MTN-039 was a phase 1, open-label, single-arm, 2-dose study. Blood, rectal fluid, and rectal tissue were collected over 72 hours following rectal administration of 1 and 2 TAF/EVG inserts for each participant. Results TAF/EVG inserts were safe and well tolerated. EVG and tenofovir (TFV) were detected in blood plasma at low concentrations: median peak concentrations after 2 inserts were EVG 2.4 ng/mL and TFV 4.4 ng/mL. Rectal tissue EVG peaked at 2 hours (median, 2 inserts = 9 ng/mg) but declined to below limit of quantification in the majority of samples at 24 hours, whereas tenofovir diphosphate (TFV-DP) remained high >2000 fmol/million cells for 72 hours with 2 inserts. Compared to baseline, median cumulative log10 HIV p24 antigen of ex vivo rectal tissue HIV infection was reduced at each time point for both 1 and 2 inserts (P < .065 and P < .039, respectively). Discussion Rectal administration of TAF/EVG inserts achieved high rectal tissue concentrations of EVG and TFV-DP with low systemic drug exposure and demonstrable ex vivo inhibition of HIV infection for 72 hours. Clinical Trials Registration . NCT04047420. Discussion Rectal administration of TAF/EVG inserts achieved high rectal tissue concentrations of EVG and TFV-DP with low systemic drug exposure and demonstrable ex vivo inhibition of HIV infection for 72 hours. Clinical Trials Registration . NCT04047420.
HIV/AIDS remains a global public health issue, and products available for the prevention of HIV infections are limited, especially those for short-acting, on-demand, user-controlled applications. Topical inserts are products that can be applied vaginally or rectally and have been explored as drug delivery systems. To fill the gap in the HIV prevention product pipeline, CONRAD has developed a topical insert containing tenofovir alafenamide fumarate (TAF) and elvitegravir (EVG), two potent and synergistic antiretrovirals, as a simple, low-cost, and discreet option that can be self-administered vaginally and/or rectally, before and after coitus. In this review, we have described the development path of the TAF/EVG insert up to its current point in clinical testing, highlighting findings from acceptability, preclinical safety, pharmacokinetics, and efficacy evaluations and early clinical studies. In summary, the TAF/EVG inserts are stable, easy to manufacture, low-cost, acceptable, and show highly promising preclinical and clinical results for on-demand topical pre- or post-exposure HIV prevention.
In this study, reproducible label-free detection and quantification of the antiretroviral drug emtricitabine (FTC) down to 78 ng/mL in human plasma by surface enhanced Raman spectroscopy (SERS) is presented. A novel plasma sample pretreatment method using silver nitrate and silver colloidal nanoparticles (Ag CNPs) was used to prepare the plasma samples for analysis. The pretreated plasma samples were evaporated to dryness on an aluminum surface and a computer-controlled Raman scanning system was used to collect spatially resolved SERS spectra of the entire surface. Calibration curves of commercial human plasma samples containing FTC in a concentration range of 5000 to 78 ng/mL were calculated using three different methods. First, a conventional approach was taken, where all the spectra collected for each concentration were averaged, then the SERS intensity of a known FTC peak (792 cm-1) was used for calibrations (total population method). This approach was refined by utilizing a figure-of-merit (FOM) quality index (Q i) to sample spectra from each concentration that contained the highest signal-to-noise (S/N), before averaging and calculating the SERS intensity of the 792 cm-1 FTC peak (Q i sample method). Finally, the distribution of all Q i values for each concentration were modeled using cumulative distribution functions (CDFs) and were used for calibrations (CDF method). The CDF method exhibited the highest analytical sensitivity (slope = 3702.47) compared to the Q i sample method (slope = 1591.05) and the total population method (slope = 754.21). The Q i sample method exhibited the highest linearity (R 2 = 0.99) compared to the CDF method (R 2 = 0.95) and the total population average (R 2 = 0.97). The CDF method exhibited the highest S/N in the concentration range of 5000 to 312 ng/mL (S/N range of 31.5-16.6). The Q i sample method exhibited the highest S/N for concentrations 156 and 78 ng/mL (S/N = 9.7 and 7.4, respectively). These results show that the Q i sample method is advantageous over all other methods when approaching the LOQ while the CDF method is advantageous over all methods at higher concentrations. The LOQ (78 ng/mL) was confirmed by principal component analysis (PCA). Together these results show that statistical treatment of a large population of SERS spectra, where the analyte signal intensity follows an exponential distribution, is superior to standard methods of averaging populations of spectra in terms of analytical sensitivity, linearity, and S/N. Additionally, it was found that the background signal had no interference with the quantitative data calculated for the total population and Q i sample methods after repeating both analyses with baseline-subtracted spectra. The results and methodology presented in this study establish a framework for integrating SERS into drug adherence monitoring for FTC-based treatment and prevention of infections by demonstrating consistent SERS detection and quantification of FTC in human plasma at therapeutically relevant concentrations.
