HIV
Conditions
Keywords
HIV, AIDS, Immunodeficiency Virus, Human, PREZISTA, darunavir, TMC114, TMC125, Protease Inhibitor, Non-Nucleoside Reverse Transcriptase Inhibitor, enfuvirtide, Treatment Experienced
Brief summary
The purpose of this study is to examine the safety, tolerability, and effectiveness of darunavir/ritonavir combined with TMC125 when current protease inhibitor(s), Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI(s)) and enfuvirtide are replaced by darunavir/ritonavir and TMC125 in HIV positive patients who can no longer tolerate enfuvirtide and are experiencing viral suppression. Other antiviral drugs in the regimen are to remain unchanged.
Detailed description
This is a multi-center, open-label (doctors and patients know which drug is being given), Phase IIIb clinical trial to evaluate the effectiveness, safety and tolerability of the combination of PREZISTA (darunavir)/ritonavir and TMC125 when substituted for enfuvirtide, current protease inhibitor(s) and Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI(s)) in antiretroviral resistant patients with viral suppression but who are intolerant of enfuvirtide. This study will be conducted in the U.S. at up to 5 sites where 40 patients will receive PREZISTA (darunavir) /ritonavir twice daily (600/100mg) and TMC125 (200 mg) twice daily over a 48-week treatment period. The study will consist of a total of 11 patient visits. At the screening visit (Week -1 to -6) blood will be collected from patients to determine eligibility. Once all data are available to determine the eligibility of the patient, the baseline visit will be scheduled and trial treatment initiated at this visit. The Baseline Visit (Day 1) will be followed by a 48-week treatment period. The patient will be evaluated at Weeks 2, 4, 8, 12, 16, 24, 36, and 48. Patients will be asked to return for a 2-week follow up visit at Week 50. Treatment will include PREZISTA (darunavir) /ritonavir and TMC125 plus continued nucleosides. The patient must continue all existing nucleosides in their background regimen for the duration of the study. During the treatment period, the patient will be seen at regular visits during which the investigator will assess the patient's medical condition, any Adverse Events and study drug compliance. Laboratory evaluations for efficacy and safety will be done at regular visits. Study patients will receive oral (by mouth) PREZISTA (darunavir) 600 mg and 100 mg of ritonavir twice a day in combination with TMC125 200mg orally twice a day for 48 weeks.
Interventions
TMC125-200mg two times a day for 48 weeks; Darunavir -200mg two times a day for 48 weeks; Ritonavir-100mg two times a day for 48 weeks;
Sponsors
Study design
Eligibility
Inclusion criteria
* Documented HIV-1 positive * History of drug resistance or antiretroviral failure while receiving each of three drug classes: Nucleoside Reverse Transcriptase Inhibitors (NRTIs), Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) and (protease inhibitors) PIs * On a PI containing regimen with enfuvirtide with HIV viral load (VL) \< 400 copies/mL for 6 months or longer * Continuously using the same PI regimen for 4 months prior to Screening * Decline to continue enfuvirtide or their physician recommends discontinuation due to injection site reactions that persist despite optimal technique and training with available methods of administration or loss of sites for injection due to tissue nodules and hardening.
Exclusion criteria
* No use of any drug contraindicated in the current US package insert for PREZISTA (darunavir) or in the investigators brochure for TMC125 * No prior or current therapy with PREZISTA (darunavir) or TMC125 * No prior genotypic results demonstrating 3 or more darunavir resistance-associated mutations associated with diminished response to darunavir (V11I, V32I, L33F, I47V, I50V, I54L, I54M, G73S, L76V, I84V or L89V). Patients with \> 3 darunavir resistance-associated mutations with available darunavir phenotypes, may be enrolled if the resistance phenotype demonstrates: Fold Change (FC) \<10 to darunavir by PhenoSense GT (Monogram Biosciences) or FC \<10 to darunavir by Antivirogram (Virco, BVBA) or FC \<3.4 to darunavir by vircoTYPE (Virco BVBA) * AST or ALT \>5 times ULN * Calculated CrCl \< 30 ml/min.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Proportion of Patients Who Maintain Plasma HIV Viral Load Measurements < 400 Copies/ml at 2, 4, 8, 12, 16, 24, 36 and 48 Weeks After Switching to DRV/r and ETR, Missing Equals Failure. | 48 weeks |
Secondary
| Measure | Time frame |
|---|---|
| CD4+ Cell Count (x 10^6 Cell/L): Baseline and Median Changes From Baseline at 4, 8, 12, 16, 24, 36 and 48 Weeks. | Week 48 |
| CD4+ Cell Count (x 10^6 Cell/L): Baseline and Mean Changes From Baseline at 4, 8, 12, 16, 24,36 and 48 Weeks. | Week 48 |
| Median Change From Baseline in Triglycerides at Week 48. | Week 48 |
| Median Change From Baseline in Total Cholesterol at Week 48. | Week 48 |
| Proportion of Patients Who Have Viral Load Measurements <50 Copies/ml at 2, 4, 8, 12, 16, 24, 36 and 48 Weeks After Switching to DRV/r and ETR, Missing Equals Failure. | 48 weeks |
| Median Change From Baseline in HDL Cholesterol. | Week 48 |
| Median Change From Baseline in Total Cholesterol (TC) / High Denisty Lipoprotein (HDL) Ratio at Week 48. | Week 48 |
| Median Change From Baseline in Glucose at Week 48. | Week 48 |
| Median Change From Baseline in LDL Cholesterol at Week 48. | Week 48 |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Darunavir(TMC114)/Eravirine(TMC125) Darunavir/ritonavir (DRV/r) combined with Etravirine (\[ETR\] also known as TMC125) when current protease inhibitor(s) (PIs), non-nucleoside reverse transriptase inhibitor(s) (NNRTIs), and enfuviritide (ENF) were replaced by DRV/r and ETR in subjects with intolerance to ENF. | 10 |
| Total | 10 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Adverse Event | 1 |
| Overall Study | Lost to Follow-up | 1 |
Baseline characteristics
| Characteristic | Darunavir(TMC114)/Eravirine(TMC125) |
|---|---|
| Age Continuous | 48 years |
| CD4 count | 301 cells/mm^3 |
| Race/Ethnicity, Customized Hispanic | 4 participants |
| Race/Ethnicity, Customized White | 6 participants |
| Sex: Female, Male Female | 0 Participants |
| Sex: Female, Male Male | 10 Participants |
| Viral Load <50 copies/mL | 10 participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 10 / 10 |
| serious Total, serious adverse events | 1 / 10 |
Outcome results
Proportion of Patients Who Maintain Plasma HIV Viral Load Measurements < 400 Copies/ml at 2, 4, 8, 12, 16, 24, 36 and 48 Weeks After Switching to DRV/r and ETR, Missing Equals Failure.
Time frame: 48 weeks
Population: ITT population. One subject (001) who discontinued due to adverse events had a VL \< 50 copies/mL at Week 4. Another subject (013) who was lost to follow-up had VL \<50 copies/mL through Week 36.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Darunavir(TMC114)/Eravirine(TMC125) | Proportion of Patients Who Maintain Plasma HIV Viral Load Measurements < 400 Copies/ml at 2, 4, 8, 12, 16, 24, 36 and 48 Weeks After Switching to DRV/r and ETR, Missing Equals Failure. | Baseline (Day 1) | 100 percentage of participants |
| Darunavir(TMC114)/Eravirine(TMC125) | Proportion of Patients Who Maintain Plasma HIV Viral Load Measurements < 400 Copies/ml at 2, 4, 8, 12, 16, 24, 36 and 48 Weeks After Switching to DRV/r and ETR, Missing Equals Failure. | Week 2 | 100 percentage of participants |
| Darunavir(TMC114)/Eravirine(TMC125) | Proportion of Patients Who Maintain Plasma HIV Viral Load Measurements < 400 Copies/ml at 2, 4, 8, 12, 16, 24, 36 and 48 Weeks After Switching to DRV/r and ETR, Missing Equals Failure. | Week 4 | 100 percentage of participants |
| Darunavir(TMC114)/Eravirine(TMC125) | Proportion of Patients Who Maintain Plasma HIV Viral Load Measurements < 400 Copies/ml at 2, 4, 8, 12, 16, 24, 36 and 48 Weeks After Switching to DRV/r and ETR, Missing Equals Failure. | Week 8 | 90 percentage of participants |
| Darunavir(TMC114)/Eravirine(TMC125) | Proportion of Patients Who Maintain Plasma HIV Viral Load Measurements < 400 Copies/ml at 2, 4, 8, 12, 16, 24, 36 and 48 Weeks After Switching to DRV/r and ETR, Missing Equals Failure. | Week 12 | 80 percentage of participants |
| Darunavir(TMC114)/Eravirine(TMC125) | Proportion of Patients Who Maintain Plasma HIV Viral Load Measurements < 400 Copies/ml at 2, 4, 8, 12, 16, 24, 36 and 48 Weeks After Switching to DRV/r and ETR, Missing Equals Failure. | Week 16 | 90 percentage of participants |
| Darunavir(TMC114)/Eravirine(TMC125) | Proportion of Patients Who Maintain Plasma HIV Viral Load Measurements < 400 Copies/ml at 2, 4, 8, 12, 16, 24, 36 and 48 Weeks After Switching to DRV/r and ETR, Missing Equals Failure. | Week 24 | 90 percentage of participants |
| Darunavir(TMC114)/Eravirine(TMC125) | Proportion of Patients Who Maintain Plasma HIV Viral Load Measurements < 400 Copies/ml at 2, 4, 8, 12, 16, 24, 36 and 48 Weeks After Switching to DRV/r and ETR, Missing Equals Failure. | Week 36 | 90 percentage of participants |
| Darunavir(TMC114)/Eravirine(TMC125) | Proportion of Patients Who Maintain Plasma HIV Viral Load Measurements < 400 Copies/ml at 2, 4, 8, 12, 16, 24, 36 and 48 Weeks After Switching to DRV/r and ETR, Missing Equals Failure. | Week 48 | 80 percentage of participants |
| Darunavir(TMC114)/Eravirine(TMC125) | Proportion of Patients Who Maintain Plasma HIV Viral Load Measurements < 400 Copies/ml at 2, 4, 8, 12, 16, 24, 36 and 48 Weeks After Switching to DRV/r and ETR, Missing Equals Failure. | Post-Treatment Follow Up | 90 percentage of participants |
CD4+ Cell Count (x 10^6 Cell/L): Baseline and Mean Changes From Baseline at 4, 8, 12, 16, 24,36 and 48 Weeks.
Time frame: Week 48
Population: ITT , LOCF.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Darunavir(TMC114)/Eravirine(TMC125) | CD4+ Cell Count (x 10^6 Cell/L): Baseline and Mean Changes From Baseline at 4, 8, 12, 16, 24,36 and 48 Weeks. | Baseline (Day 1) | 338.3 cells/mm^3 | Standard Deviation 135.91 |
| Darunavir(TMC114)/Eravirine(TMC125) | CD4+ Cell Count (x 10^6 Cell/L): Baseline and Mean Changes From Baseline at 4, 8, 12, 16, 24,36 and 48 Weeks. | Week 4 Change from Baseline | 2.3 cells/mm^3 | Standard Deviation 31.22 |
| Darunavir(TMC114)/Eravirine(TMC125) | CD4+ Cell Count (x 10^6 Cell/L): Baseline and Mean Changes From Baseline at 4, 8, 12, 16, 24,36 and 48 Weeks. | Week 8 Change from Baseline | -25.0 cells/mm^3 | Standard Deviation 72.04 |
| Darunavir(TMC114)/Eravirine(TMC125) | CD4+ Cell Count (x 10^6 Cell/L): Baseline and Mean Changes From Baseline at 4, 8, 12, 16, 24,36 and 48 Weeks. | Week 12 Change from Baseline | -18.9 cells/mm^3 | Standard Deviation 44.25 |
| Darunavir(TMC114)/Eravirine(TMC125) | CD4+ Cell Count (x 10^6 Cell/L): Baseline and Mean Changes From Baseline at 4, 8, 12, 16, 24,36 and 48 Weeks. | Week 16 Change from Baseline | 0.5 cells/mm^3 | Standard Deviation 53.58 |
| Darunavir(TMC114)/Eravirine(TMC125) | CD4+ Cell Count (x 10^6 Cell/L): Baseline and Mean Changes From Baseline at 4, 8, 12, 16, 24,36 and 48 Weeks. | Week 24 Change from Baseline | 24.5 cells/mm^3 | Standard Deviation 34 |
| Darunavir(TMC114)/Eravirine(TMC125) | CD4+ Cell Count (x 10^6 Cell/L): Baseline and Mean Changes From Baseline at 4, 8, 12, 16, 24,36 and 48 Weeks. | Week 36 Change from Baseline | 22.7 cells/mm^3 | Standard Deviation 58.84 |
| Darunavir(TMC114)/Eravirine(TMC125) | CD4+ Cell Count (x 10^6 Cell/L): Baseline and Mean Changes From Baseline at 4, 8, 12, 16, 24,36 and 48 Weeks. | Week 48 Change from Baseline | 47.3 cells/mm^3 | Standard Deviation 48.03 |
CD4+ Cell Count (x 10^6 Cell/L): Baseline and Median Changes From Baseline at 4, 8, 12, 16, 24, 36 and 48 Weeks.
Time frame: Week 48
Population: Intent To Treat (ITT), last observation carried forward (LOCF).
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Darunavir(TMC114)/Eravirine(TMC125) | CD4+ Cell Count (x 10^6 Cell/L): Baseline and Median Changes From Baseline at 4, 8, 12, 16, 24, 36 and 48 Weeks. | Week 48 Change from Baseline | 63.5 cells/mm^3 |
| Darunavir(TMC114)/Eravirine(TMC125) | CD4+ Cell Count (x 10^6 Cell/L): Baseline and Median Changes From Baseline at 4, 8, 12, 16, 24, 36 and 48 Weeks. | Baseline (Day 1) | 301.0 cells/mm^3 |
| Darunavir(TMC114)/Eravirine(TMC125) | CD4+ Cell Count (x 10^6 Cell/L): Baseline and Median Changes From Baseline at 4, 8, 12, 16, 24, 36 and 48 Weeks. | Week 4 Change from Baseline | -12.0 cells/mm^3 |
| Darunavir(TMC114)/Eravirine(TMC125) | CD4+ Cell Count (x 10^6 Cell/L): Baseline and Median Changes From Baseline at 4, 8, 12, 16, 24, 36 and 48 Weeks. | Week 8 Change from Baseline | -32.0 cells/mm^3 |
| Darunavir(TMC114)/Eravirine(TMC125) | CD4+ Cell Count (x 10^6 Cell/L): Baseline and Median Changes From Baseline at 4, 8, 12, 16, 24, 36 and 48 Weeks. | Week 12 Change from Baseline | -17.0 cells/mm^3 |
| Darunavir(TMC114)/Eravirine(TMC125) | CD4+ Cell Count (x 10^6 Cell/L): Baseline and Median Changes From Baseline at 4, 8, 12, 16, 24, 36 and 48 Weeks. | Week 16 Change from Baseline | -7.0 cells/mm^3 |
| Darunavir(TMC114)/Eravirine(TMC125) | CD4+ Cell Count (x 10^6 Cell/L): Baseline and Median Changes From Baseline at 4, 8, 12, 16, 24, 36 and 48 Weeks. | Week 24 Change from Baseline | 19.0 cells/mm^3 |
| Darunavir(TMC114)/Eravirine(TMC125) | CD4+ Cell Count (x 10^6 Cell/L): Baseline and Median Changes From Baseline at 4, 8, 12, 16, 24, 36 and 48 Weeks. | Week 36 Change from Baseline | 38.0 cells/mm^3 |
Median Change From Baseline in Glucose at Week 48.
Time frame: Week 48
Population: ITT , LOCF.
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Darunavir(TMC114)/Eravirine(TMC125) | Median Change From Baseline in Glucose at Week 48. | Baseline (Day 1) | 92.5 mg/dL |
| Darunavir(TMC114)/Eravirine(TMC125) | Median Change From Baseline in Glucose at Week 48. | Week 48 Change from Baseline | 1.0 mg/dL |
Median Change From Baseline in HDL Cholesterol.
Time frame: Week 48
Population: ITT , LOCF.
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Darunavir(TMC114)/Eravirine(TMC125) | Median Change From Baseline in HDL Cholesterol. | Baseline (Day 1) | 47.5 mg/dL |
| Darunavir(TMC114)/Eravirine(TMC125) | Median Change From Baseline in HDL Cholesterol. | Week 48 Change from Baseline | -2.5 mg/dL |
Median Change From Baseline in LDL Cholesterol at Week 48.
Time frame: Week 48
Population: ITT , LOCF.
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Darunavir(TMC114)/Eravirine(TMC125) | Median Change From Baseline in LDL Cholesterol at Week 48. | Baseline (Day 1) | 100.0 mg/dL |
| Darunavir(TMC114)/Eravirine(TMC125) | Median Change From Baseline in LDL Cholesterol at Week 48. | Week 48 Change from Baseline | -9.0 mg/dL |
Median Change From Baseline in Total Cholesterol at Week 48.
Time frame: Week 48
Population: ITT , LOCF.
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Darunavir(TMC114)/Eravirine(TMC125) | Median Change From Baseline in Total Cholesterol at Week 48. | Baseline (Day 1) | 189.0 mg/dL |
| Darunavir(TMC114)/Eravirine(TMC125) | Median Change From Baseline in Total Cholesterol at Week 48. | Week 48 Change from Baseline | -27.5 mg/dL |
Median Change From Baseline in Total Cholesterol (TC) / High Denisty Lipoprotein (HDL) Ratio at Week 48.
Time frame: Week 48
Population: ITT , LOCF.
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Darunavir(TMC114)/Eravirine(TMC125) | Median Change From Baseline in Total Cholesterol (TC) / High Denisty Lipoprotein (HDL) Ratio at Week 48. | Baseline (Day 1) | 4.7 ratio of TC and HDL |
| Darunavir(TMC114)/Eravirine(TMC125) | Median Change From Baseline in Total Cholesterol (TC) / High Denisty Lipoprotein (HDL) Ratio at Week 48. | Week 48 Change from Baseline | -0.3 ratio of TC and HDL |
Median Change From Baseline in Triglycerides at Week 48.
Time frame: Week 48
Population: ITT , LOCF.
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Darunavir(TMC114)/Eravirine(TMC125) | Median Change From Baseline in Triglycerides at Week 48. | Baseline (Day 1) | 229.0 mg/dL |
| Darunavir(TMC114)/Eravirine(TMC125) | Median Change From Baseline in Triglycerides at Week 48. | Week 48 Change from Baseline | -24.5 mg/dL |
Proportion of Patients Who Have Viral Load Measurements <50 Copies/ml at 2, 4, 8, 12, 16, 24, 36 and 48 Weeks After Switching to DRV/r and ETR, Missing Equals Failure.
Time frame: 48 weeks
Population: ITT population. One subject (001) who discontinued due to adverse events had a VL \< 50 copies/mL at Week 4. Another subject (013) who was lost to follow-up had VL \<50 copies/mL through Week 36.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Darunavir(TMC114)/Eravirine(TMC125) | Proportion of Patients Who Have Viral Load Measurements <50 Copies/ml at 2, 4, 8, 12, 16, 24, 36 and 48 Weeks After Switching to DRV/r and ETR, Missing Equals Failure. | Baseline (Day 1) | 100 percentage of participants |
| Darunavir(TMC114)/Eravirine(TMC125) | Proportion of Patients Who Have Viral Load Measurements <50 Copies/ml at 2, 4, 8, 12, 16, 24, 36 and 48 Weeks After Switching to DRV/r and ETR, Missing Equals Failure. | Week 2 | 90 percentage of participants |
| Darunavir(TMC114)/Eravirine(TMC125) | Proportion of Patients Who Have Viral Load Measurements <50 Copies/ml at 2, 4, 8, 12, 16, 24, 36 and 48 Weeks After Switching to DRV/r and ETR, Missing Equals Failure. | Week 4 | 90 percentage of participants |
| Darunavir(TMC114)/Eravirine(TMC125) | Proportion of Patients Who Have Viral Load Measurements <50 Copies/ml at 2, 4, 8, 12, 16, 24, 36 and 48 Weeks After Switching to DRV/r and ETR, Missing Equals Failure. | Week 8 | 90 percentage of participants |
| Darunavir(TMC114)/Eravirine(TMC125) | Proportion of Patients Who Have Viral Load Measurements <50 Copies/ml at 2, 4, 8, 12, 16, 24, 36 and 48 Weeks After Switching to DRV/r and ETR, Missing Equals Failure. | Week 12 | 80 percentage of participants |
| Darunavir(TMC114)/Eravirine(TMC125) | Proportion of Patients Who Have Viral Load Measurements <50 Copies/ml at 2, 4, 8, 12, 16, 24, 36 and 48 Weeks After Switching to DRV/r and ETR, Missing Equals Failure. | Week 16 | 90 percentage of participants |
| Darunavir(TMC114)/Eravirine(TMC125) | Proportion of Patients Who Have Viral Load Measurements <50 Copies/ml at 2, 4, 8, 12, 16, 24, 36 and 48 Weeks After Switching to DRV/r and ETR, Missing Equals Failure. | Week 24 | 90 percentage of participants |
| Darunavir(TMC114)/Eravirine(TMC125) | Proportion of Patients Who Have Viral Load Measurements <50 Copies/ml at 2, 4, 8, 12, 16, 24, 36 and 48 Weeks After Switching to DRV/r and ETR, Missing Equals Failure. | Week 36 | 90 percentage of participants |
| Darunavir(TMC114)/Eravirine(TMC125) | Proportion of Patients Who Have Viral Load Measurements <50 Copies/ml at 2, 4, 8, 12, 16, 24, 36 and 48 Weeks After Switching to DRV/r and ETR, Missing Equals Failure. | Week 48 | 80 percentage of participants |
| Darunavir(TMC114)/Eravirine(TMC125) | Proportion of Patients Who Have Viral Load Measurements <50 Copies/ml at 2, 4, 8, 12, 16, 24, 36 and 48 Weeks After Switching to DRV/r and ETR, Missing Equals Failure. | Post-Treatment Follow Up | 90 percentage of participants |