Placental transfer of doravirine, a recent HIV-1 NNRTI in the ex vivo human cotyledon perfusion model

Background The recent HIV-1 NNRTI doravirine is likely to be used in pregnant women despite the complete lack of data on safety and exposure in the fetus. The objective of this study was to determine its placental transfer. Methods Maternal-to-fetal transfer was investigated using the open-circuit ex vivo dually perfused human cotyledon model. Doravirine was added to a maternal perfusate (theoretical doravirine concentration of 250 ng/mL) containing 2 g/L human albumin and 20 g/L antipyrine, a marker to validate the cotyledon’s viability, and cotyledons were dually perfused for up to 90 min. Results In five experiments, the median (IQR) doravirine concentrations in the maternal and fetal compartments were, respectively, 303 (178–420) and 40 (30–54) ng/mL, the fetal-to-maternal ratio was 16% (12%–18%) and the clearance index (in comparison with antipyrine transfer) was 48% (35%–64%). The median accumulation index in cotyledon tissue was 39% (range 10%–66%). Conclusions Doravirine both crosses and accumulates in the placenta. This may be useful as pre/post-exposure prophylaxis to reduce the risk of vertical HIV transmission but carries the potential for fetal toxicities. Further investigation is required to determine the safety and efficacy of this new antiretroviral agent in pregnancy.