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Study to Evaluate Switching From Regimens Consisting of a Ritonavir-boosted Protease Inhibitor (PI) and Two Nucleoside Reverse Transcriptase Inhibitors (NRTIs) to a Fixed-dose Tablet Containing Emtricitabine/Rilpivirine/Tenofovir DF

A Phase 3 Randomized, Open Label Study to Evaluate Switching From Regimens Consisting of a Ritonavir-boosted Protease Inhibitor and Two Nucleoside Reverse Transcriptase Inhibitors to Emtricitabine/Rilpivirine/Tenofovir Disoproxil Fumarate (FTC/RPV/TDF) Fixed-dose Regimen in Virologically Suppressed, HIV-1 Infected Patients

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01252940
Enrollment
482
Registered
2010-12-03
Start date
2010-11-30
Completion date
2014-10-31
Last updated
2015-12-04

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

HIV-1 Infection

Keywords

HIV-1, HIV, Treatment Experienced

Brief summary

The purpose of this randomized, open-label, multicenter, active-controlled Phase 3b study is to evaluate the noninferiority of the emtricitabine/rilpivirine/tenofovir disoproxil fumarate (FTC/RPV/TDF) single-tablet regimen (STR; also referred to as fixed-dose regimen or fixed-dose tablet) relative to regimens consisting of a ritonavir-boosted protease inhibitor (PI+RTV) and two nucleoside reverse transcriptase inhibitors (NRTIs) in virologically suppressed, HIV-1 infected subjects. The FTC/RPV/TDF STR could offer an attractive treatment option to patients who wish to simplify dosing by reducing pill burden or to improve the tolerability of their treatment. Participants will be randomized into 2 groups, the FTC/RPV/TDF STR group, in which participants will switch treatment regimens at the start of the study, and the Stay on Baseline Regimen (SBR)/Delayed Switch group, in which participants will remain on their baseline regimen during the first 24 weeks of the study (designed to provide an initial active control), and may switch to the FTC/RPV/TDF STR at the Week 24 visit. After the 48-week study analysis period, participants may continue to receive the FTC/RPV/TDF STR per protocol before switching to a commercially available source.

Interventions

Emtricitabine (FTC) 200 mg/rilpivirine (RPV) 25 mg/tenofovir disoproxil fumarate (tenofovir DF; TDF) 300 mg single-tablet regimen (STR) administered orally with a meal once daily (QD)

DRUGPI

Protease inhibitors (PIs) included amprenavir, atazanavir, darunavir, fosamprenavir, Kaletra (lopinavir/ritonavir, coformulated), ritonavir, and saquinavir. PIs were administered according to prescribing information.

DRUGRTV

Ritonavir (RTV) was administered according to prescribing information.

DRUGNRTIs

NRTIs included abacavir, emtricitabine, Combivir (lamivudine/zidovudine, coformulated), Epzicom (abacavir/lamivudine, coformulated), lamivudine, stavudine, tenofovir DF, Truvada® (emtricitabine/tenofovir DF, coformulated), and zidovudine. NRTIs were administered according to prescribing information.

Sponsors

Gilead Sciences
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* Ability to understand and sign a written informed consent form * Receiving antiretroviral therapy with a ritonavir-boosted PI and two NRTIs continuously for ≥ 6 months preceding the screening visit * Plasma HIV-1 RNA concentrations (at least two measurements) at undetectable levels for ≥ 6 months prior to the screening visit and HIV-1 RNA \< 50 copies/mL at the screening visit * On their first or second antiretroviral drug regimen; if on their second regimen, HIV-1 RNA ≤ 50 copies/mL required at the time of the first change in antiretroviral drugs, and no HIV RNA \> 50 copies/mL measured at two consecutive time points after first achieving HIV RNA \< 50 copies/mL * No previous use of any approved or experimental nonnucleoside reverse transcriptase inhibitor (NNRTI) drug for any length of time * Have a genotype prior to starting initial antiretroviral therapy and no known resistance to any of the study agents * Normal ECG * Hepatic transaminases (AST and ALT) ≤ 5 x upper limit of normal (ULN) * Total bilirubin ≤ 1.5 mg/dL, or normal direct bilirubin * Adequate hematologic function (absolute neutrophil count ≥ 1,000/mm\^3; platelets ≥ 50,000/mm\^3; hemoglobin ≥ 8.5 g/dL) * Serum amylase ≤ 5 x ULN (subjects with serum amylase \> 5 x ULN eligible if serum lipase ≤ 5 x ULN) * Adequate renal function (estimated glomerular filtration rate ≥ 70 mL/min according to the Cockcroft-Gault formula) * Males and females of childbearing potential must agree to utilize highly effective contraception methods (two separate forms of contraception, one of which must have been an effective barrier method, or been nonheterosexually active, practice sexual abstinence, or have a vasectomized partner) from screening throughout the duration of the study period and for 30 days following the last dose of study drug. * Age ≥ 18 years * Life expectancy ≥ 1 year

Exclusion criteria

* A new AIDS-defining condition diagnosed within 30 days prior to screening except cluster of differentiation 4 (CD4) cell count and/or percentage criteria * Females who are breastfeeding * Positive serum pregnancy test (female of childbearing potential) * Proven or suspected acute hepatitis 30 days prior to study entry. * Current alcohol or substance abuse judged by the Investigator to potentially interfere with subject compliance. * History of malignancy within 5 years prior to study entry or ongoing malignancy other than cutaneous Kaposi's sarcoma, basal cell carcinoma, or resected, noninvasive cutaneous squamous carcinoma * Active, serious infections requiring parenteral antibiotic or antifungal therapy within 30 days prior to baseline * Anticipated need to initiate contraindicated drugs during the study, including drugs not to be used with FTC, TDF, RPV; or subjects with known allergies to the excipients of FTC/RPV/TDF STR tablets or Truvada® tablets * All investigational drugs * Medications and use of herbal/natural supplements excluded or to be used with caution while participating in the study, including those not to be taken with Viread®, Emtriva®, Truvada, and Rilpivirine. * Participation in any other clinical trial without prior approval from the sponsor was prohibited while participating in this trial * Treatment with immunosuppressant therapies or chemotherapeutic agents within 3 months of study screening, or expected to receive these agents or systemic steroids during the study * History of liver disease, including Gilbert's Disease * Any other clinical condition or prior therapy making the subject unsuitable for the study or unable to comply with the dosing requirements

Design outcomes

Primary

MeasureTime frameDescription
Percentage of Participants With HIV-1 RNA < 50 Copies/mL at Week 24 (FDA Snapshot Analysis)Week 24The percentage of participants with HIV-1 RNA \< 50 copies/mL at Week 24 was analyzed using the FDA snapshot analysis.

Secondary

MeasureTime frameDescription
Change From Baseline in Cluster of Differentiation 4 (CD4) Count Through Week 24Baseline to Week 24The mean (SD) change in CD4 count was analyzed from baseline through Week 24.
Change From Baseline in CD4 Count Through Week 48Baseline to Week 48The mean (SD) change in CD4 count was analyzed from baseline through Week 48. By Week 48, participants FTC/RPV/TDF had received 48 weeks of treatment with FTC/RPV/TDF, while those in the SBR/Delayed Switch group had received only 24 weeks of treatment with FTC/RPV/TDF.
Change From Baseline in Fasting Total Cholesterol Through Week 24Baseline to Week 24The mean (SD) change from baseline in fasting total cholesterol (mg/dL) through Week 24 was analyzed.
Change From Baseline in Fasting Total Cholesterol Through Week 48Baseline to Week 48The mean (SD) change from baseline in fasting total cholesterol (mg/dL) through Week 48 was analyzed. By Week 48, participants FTC/RPV/TDF had received 48 weeks of treatment with FTC/RPV/TDF, while those in the SBR/Delayed Switch group had received only 24 weeks of treatment with FTC/RPV/TDF.
Change From Baseline in Fasting High-density Lipoprotein (HDL) Cholesterol Through Week 24Baseline to Week 24The mean (SD) change from baseline in fasting HDL cholesterol (mg/dL) through Week 24 was analyzed.
Percentage of Participants With HIV-1 RNA < 50 Copies/mL at Week 48 (FDA Snapshot Analysis)Week 48The percentage of participants with HIV-1 RNA \< 50 copies/mL at Week 48 was analyzed using the FDA snapshot analysis. By Week 48, participants FTC/RPV/TDF had received 48 weeks of treatment with FTC/RPV/TDF, while those in the SBR/Delayed Switch group had received only 24 weeks of treatment with FTC/RPV/TDF.
Change From Baseline in Fasting Direct Low-density Lipoprotein (LDL) Cholesterol Through Week 24Baseline to Week 24The mean (SD) change from baseline in fasting direct LDL cholesterol (mg/dL) through Week 24 was analyzed.
Change From Baseline in Fasting Direct LDL Cholesterol Through Week 48Baseline to Week 48The mean (SD) change from baseline in fasting direct LDL cholesterol (mg/dL) through Week 48 was analyzed. By Week 48, participants FTC/RPV/TDF had received 48 weeks of treatment with FTC/RPV/TDF, while those in the SBR/Delayed Switch group had received only 24 weeks of treatment with FTC/RPV/TDF.
Change From Baseline in Fasting Triglycerides Through Week 24Baseline to Week 24The mean (SD) change from baseline in fasting triglycerides through Week 24 was analyzed.
Change From Baseline in Fasting Triglycerides Through Week 48Baseline to Week 48The mean (SD) change from baseline in fasting triglycerides through Week 48 was analyzed. By Week 48, participants FTC/RPV/TDF had received 48 weeks of treatment with FTC/RPV/TDF, while those in the SBR/Delayed Switch group had received only 24 weeks of treatment with FTC/RPV/TDF.
Change From Baseline in Fasting HDL Cholesterol Through Week 48Baseline to Week 48The mean (SD) change from baseline in fasting HDL cholesterol (mg/dL) through Week 48 was analyzed. By Week 48, participants FTC/RPV/TDF had received 48 weeks of treatment with FTC/RPV/TDF, while those in the SBR/Delayed Switch group had received only 24 weeks of treatment with FTC/RPV/TDF.

Countries

Austria, Belgium, Canada, France, Germany, Italy, Puerto Rico, Spain, United Kingdom, United States

Participant flow

Recruitment details

Participants were enrolled at 110 sites in the North America and Europe. The first participant was screened on 17 November 2010. The last participant observation was on 28 October 2014.

Pre-assignment details

617 participants were screened.

Participants by arm

ArmCount
FTC/RPV/TDF
Participants were randomized to switch from their existing treatment regimen to the FTC/RPV/TDF STR at the beginning of the study.
317
SBR/Delayed Switch
Participants were randomized to stay on their existing treatment regimen (Stay on Baseline Regimen (SBR)) at the beginning of the study through Week 24, and switch to the FTC/RPV/TDF STR (Delayed Switch) at the Week 24 visit.
159
Total476

Withdrawals & dropouts

PeriodReasonFG000FG001
Extension PhaseAdverse Event21
Extension PhaseLack of Efficacy10
Extension PhaseLost to Follow-up50
Extension PhasePhysician Decision01
Extension PhaseSubject Non-compliance10
Extension PhaseWithdrawal by Subject11
Main Study PhaseAdverse Event31
Main Study PhaseLack of Efficacy10
Main Study PhaseLost to Follow-up61
Main Study PhasePhysician Decision10
Main Study PhaseProtocol Violation42
Main Study PhaseRandomized but not treated42
Main Study PhaseSubject Non-compliance11
Main Study PhaseWithdrawal by Subject65

Baseline characteristics

CharacteristicFTC/RPV/TDFTotalSBR/Delayed Switch
Age, Continuous41 years
STANDARD_DEVIATION 9.2
42 years
STANDARD_DEVIATION 9.4
43 years
STANDARD_DEVIATION 9.7
Baseline HIV-1 RNA Category
≥ 1000 Copies/mL
4 participants5 participants1 participants
Baseline HIV-1 RNA Category
200 to < 400 Copies/mL
2 participants2 participants0 participants
Baseline HIV-1 RNA Category
400 to < 1000 Copies/mL
2 participants2 participants0 participants
Baseline HIV-1 RNA Category
< 50 Copies/mL
299 participants451 participants152 participants
Baseline HIV-1 RNA Category
50 to < 200 Copies/mL
10 participants16 participants6 participants
Ethnicity (NIH/OMB)
Hispanic or Latino
51 Participants82 Participants31 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
264 Participants392 Participants128 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
2 Participants2 Participants0 Participants
Race/Ethnicity, Customized
American Indian or Alaska Native
3 participants5 participants2 participants
Race/Ethnicity, Customized
Asian
6 participants8 participants2 participants
Race/Ethnicity, Customized
Black or African American
61 participants83 participants22 participants
Race/Ethnicity, Customized
Other
6 participants15 participants9 participants
Race/Ethnicity, Customized
White
241 participants365 participants124 participants
Region of Enrollment
Austria
18 participants26 participants8 participants
Region of Enrollment
Belgium
15 participants28 participants13 participants
Region of Enrollment
Canada
15 participants25 participants10 participants
Region of Enrollment
France
29 participants43 participants14 participants
Region of Enrollment
Germany
31 participants43 participants12 participants
Region of Enrollment
Italy
16 participants26 participants10 participants
Region of Enrollment
Puerto Rico
16 participants18 participants2 participants
Region of Enrollment
Spain
15 participants20 participants5 participants
Region of Enrollment
United Kingdom
17 participants23 participants6 participants
Region of Enrollment
United States
149 participants230 participants81 participants
Sex: Female, Male
Female
44 Participants59 Participants15 Participants
Sex: Female, Male
Male
273 Participants417 Participants144 Participants
Stratification based on antiretroviral (ARV) use
Non-TDF-containing regimen + LPV/RTV
15 participants24 participants9 participants
Stratification based on antiretroviral (ARV) use
Non-TDF-containing regimen + Other PI+RTV
42 participants62 participants20 participants
Stratification based on antiretroviral (ARV) use
TDF or FTC/TDF + lopinavir (LPV)/ritonavir (RTV)
82 participants131 participants49 participants
Stratification based on antiretroviral (ARV) use
TDF or FTC/TDF + Other PI+RTV
178 participants259 participants81 participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
deaths
Total, all-cause mortality
— / —— / —— / —
other
Total, other adverse events
150 / 31738 / 15959 / 152
serious
Total, serious adverse events
21 / 3178 / 1599 / 152

Outcome results

Primary

Percentage of Participants With HIV-1 RNA < 50 Copies/mL at Week 24 (FDA Snapshot Analysis)

The percentage of participants with HIV-1 RNA \< 50 copies/mL at Week 24 was analyzed using the FDA snapshot analysis.

Time frame: Week 24

Population: Full Analysis Set: participants who were randomized into the study and received at least one dose of study drug.

ArmMeasureValue (NUMBER)
FTC/RPV/TDFPercentage of Participants With HIV-1 RNA < 50 Copies/mL at Week 24 (FDA Snapshot Analysis)93.7 percentage of participants
SBR/Delayed SwitchPercentage of Participants With HIV-1 RNA < 50 Copies/mL at Week 24 (FDA Snapshot Analysis)89.9 percentage of participants
95% CI: [-1.6, 9.1]
Secondary

Change From Baseline in CD4 Count Through Week 48

The mean (SD) change in CD4 count was analyzed from baseline through Week 48. By Week 48, participants FTC/RPV/TDF had received 48 weeks of treatment with FTC/RPV/TDF, while those in the SBR/Delayed Switch group had received only 24 weeks of treatment with FTC/RPV/TDF.

Time frame: Baseline to Week 48

Population: Participants in the Full Analysis Set who had CD4 measurements at both baseline and Week 48 were analyzed.

ArmMeasureValue (MEAN)Dispersion
FTC/RPV/TDFChange From Baseline in CD4 Count Through Week 4810 cells/mm^3Standard Deviation 144.1
SBR/Delayed SwitchChange From Baseline in CD4 Count Through Week 48-7 cells/mm^3Standard Deviation 154.1
Secondary

Change From Baseline in Cluster of Differentiation 4 (CD4) Count Through Week 24

The mean (SD) change in CD4 count was analyzed from baseline through Week 24.

Time frame: Baseline to Week 24

Population: Participants in the Full Analysis Set who had CD4 measurements at both baseline and Week 24 were analyzed.

ArmMeasureValue (MEAN)Dispersion
FTC/RPV/TDFChange From Baseline in Cluster of Differentiation 4 (CD4) Count Through Week 2420 cells/mm^3Standard Deviation 149.3
SBR/Delayed SwitchChange From Baseline in Cluster of Differentiation 4 (CD4) Count Through Week 2432 cells/mm^3Standard Deviation 158.1
Secondary

Change From Baseline in Fasting Direct LDL Cholesterol Through Week 48

The mean (SD) change from baseline in fasting direct LDL cholesterol (mg/dL) through Week 48 was analyzed. By Week 48, participants FTC/RPV/TDF had received 48 weeks of treatment with FTC/RPV/TDF, while those in the SBR/Delayed Switch group had received only 24 weeks of treatment with FTC/RPV/TDF.

Time frame: Baseline to Week 48

Population: Participants in the Safety Analysis Set who had measurements for direct LDL cholesterol at both baseline and Week 48 were analyzed.

ArmMeasureValue (MEAN)Dispersion
FTC/RPV/TDFChange From Baseline in Fasting Direct LDL Cholesterol Through Week 48-16 mg/dLStandard Deviation 27.1
SBR/Delayed SwitchChange From Baseline in Fasting Direct LDL Cholesterol Through Week 48-14 mg/dLStandard Deviation 26.8
Secondary

Change From Baseline in Fasting Direct Low-density Lipoprotein (LDL) Cholesterol Through Week 24

The mean (SD) change from baseline in fasting direct LDL cholesterol (mg/dL) through Week 24 was analyzed.

Time frame: Baseline to Week 24

Population: Participants in the Safety Analysis Set who had measurements for direct LDL cholesterol at both baseline and Week 24 were analyzed.

ArmMeasureValue (MEAN)Dispersion
FTC/RPV/TDFChange From Baseline in Fasting Direct Low-density Lipoprotein (LDL) Cholesterol Through Week 24-16 mg/dLStandard Deviation 25.6
SBR/Delayed SwitchChange From Baseline in Fasting Direct Low-density Lipoprotein (LDL) Cholesterol Through Week 240 mg/dLStandard Deviation 23.7
Secondary

Change From Baseline in Fasting HDL Cholesterol Through Week 48

The mean (SD) change from baseline in fasting HDL cholesterol (mg/dL) through Week 48 was analyzed. By Week 48, participants FTC/RPV/TDF had received 48 weeks of treatment with FTC/RPV/TDF, while those in the SBR/Delayed Switch group had received only 24 weeks of treatment with FTC/RPV/TDF.

Time frame: Baseline to Week 48

Population: Participants in the Safety Analysis Set who had measurements for HDL cholesterol at both baseline and Week 48 were analyzed.

ArmMeasureValue (MEAN)Dispersion
FTC/RPV/TDFChange From Baseline in Fasting HDL Cholesterol Through Week 48-2 mg/dLStandard Deviation 11.6
SBR/Delayed SwitchChange From Baseline in Fasting HDL Cholesterol Through Week 48-2 mg/dLStandard Deviation 8
Secondary

Change From Baseline in Fasting High-density Lipoprotein (HDL) Cholesterol Through Week 24

The mean (SD) change from baseline in fasting HDL cholesterol (mg/dL) through Week 24 was analyzed.

Time frame: Baseline to Week 24

Population: Participants in the Safety Analysis Set who had measurements for HDL cholesterol at both baseline and Week 24 were analyzed.

ArmMeasureValue (MEAN)Dispersion
FTC/RPV/TDFChange From Baseline in Fasting High-density Lipoprotein (HDL) Cholesterol Through Week 24-4 mg/dLStandard Deviation 10.3
SBR/Delayed SwitchChange From Baseline in Fasting High-density Lipoprotein (HDL) Cholesterol Through Week 24-1 mg/dLStandard Deviation 8.2
Secondary

Change From Baseline in Fasting Total Cholesterol Through Week 24

The mean (SD) change from baseline in fasting total cholesterol (mg/dL) through Week 24 was analyzed.

Time frame: Baseline to Week 24

Population: Participants in the Safety Analysis Set who had measurements for total cholesterol at both baseline and Week 24 were analyzed.

ArmMeasureValue (MEAN)Dispersion
FTC/RPV/TDFChange From Baseline in Fasting Total Cholesterol Through Week 24-25 mg/dLStandard Deviation 30.2
SBR/Delayed SwitchChange From Baseline in Fasting Total Cholesterol Through Week 24-1 mg/dLStandard Deviation 25.9
Secondary

Change From Baseline in Fasting Total Cholesterol Through Week 48

The mean (SD) change from baseline in fasting total cholesterol (mg/dL) through Week 48 was analyzed. By Week 48, participants FTC/RPV/TDF had received 48 weeks of treatment with FTC/RPV/TDF, while those in the SBR/Delayed Switch group had received only 24 weeks of treatment with FTC/RPV/TDF.

Time frame: Baseline to Week 48

Population: Participants in the Safety Analysis Set who had measurements for total cholesterol at both baseline and Week 48 were analyzed.

ArmMeasureValue (MEAN)Dispersion
FTC/RPV/TDFChange From Baseline in Fasting Total Cholesterol Through Week 48-24 mg/dLStandard Deviation 32.9
SBR/Delayed SwitchChange From Baseline in Fasting Total Cholesterol Through Week 48-24 mg/dLStandard Deviation 32
Secondary

Change From Baseline in Fasting Triglycerides Through Week 24

The mean (SD) change from baseline in fasting triglycerides through Week 24 was analyzed.

Time frame: Baseline to Week 24

Population: Participants in the Safety Analysis Set who had measurements for triglycerides at both baseline and Week 24 were analyzed.

ArmMeasureValue (MEAN)Dispersion
FTC/RPV/TDFChange From Baseline in Fasting Triglycerides Through Week 24-53 mg/dLStandard Deviation 110
SBR/Delayed SwitchChange From Baseline in Fasting Triglycerides Through Week 243 mg/dLStandard Deviation 100.1
Secondary

Change From Baseline in Fasting Triglycerides Through Week 48

The mean (SD) change from baseline in fasting triglycerides through Week 48 was analyzed. By Week 48, participants FTC/RPV/TDF had received 48 weeks of treatment with FTC/RPV/TDF, while those in the SBR/Delayed Switch group had received only 24 weeks of treatment with FTC/RPV/TDF.

Time frame: Baseline to Week 48

Population: Participants in the Safety Analysis Set who had measurements for triglycerides at both baseline and Week 48 were analyzed.

ArmMeasureValue (MEAN)Dispersion
FTC/RPV/TDFChange From Baseline in Fasting Triglycerides Through Week 48-64 mg/dLStandard Deviation 126.4
SBR/Delayed SwitchChange From Baseline in Fasting Triglycerides Through Week 48-80 mg/dLStandard Deviation 141.1
Secondary

Percentage of Participants With HIV-1 RNA < 50 Copies/mL at Week 48 (FDA Snapshot Analysis)

The percentage of participants with HIV-1 RNA \< 50 copies/mL at Week 48 was analyzed using the FDA snapshot analysis. By Week 48, participants FTC/RPV/TDF had received 48 weeks of treatment with FTC/RPV/TDF, while those in the SBR/Delayed Switch group had received only 24 weeks of treatment with FTC/RPV/TDF.

Time frame: Week 48

Population: Participants in the Full Analysis Set in the FTC/RPV/TDF and the Delayed Switch to FTC/RPV/TDF groups were analyzed.

ArmMeasureValue (NUMBER)
FTC/RPV/TDFPercentage of Participants With HIV-1 RNA < 50 Copies/mL at Week 48 (FDA Snapshot Analysis)89.3 percentage of participants
SBR/Delayed SwitchPercentage of Participants With HIV-1 RNA < 50 Copies/mL at Week 48 (FDA Snapshot Analysis)92.1 percentage of participants

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026