HIV-1
Conditions
Brief summary
This is a study to assess long-term safety and efficacy of lersivirine in patients who have completed 96 weeks of treatment with lersivirine in studies A5271015 and A5271022.
Detailed description
The trial was terminated prematurely on January 29, 2013, due to the decision of the sponsor to discontinue development of lersivirine. The decision to terminate the trial was not based on any safety or efficacy concerns.
Interventions
Lersivirine 500 mg tablets PO taken once daily + tenofovir DF 300 mg/emtricitabine 200 mg tablets PO once daily
Efavirenz 600 mg tablets PO taken once daily + tenofovir DF 300 mg/emtricitabine 200 mg tablets PO once daily
Etravirine 200 mg PO tablets + darunavir 600 mg tablets/ritonavir 100 mg tablets or capsules taken twice daily + 1 optimized NRTI
Sponsors
Study design
Eligibility
Inclusion criteria
* Patients must complete of 96 weeks of treatment with lersivirine (or comparator where required by local regulation) in one of the parent protocols (A5271015 or A5271022). * Patients must have had a viral load less than 50 copies/mL at Week 84 of the parent protocol. * For women who can have children, a negative urine pregnancy test at the Day 1 visit.
Exclusion criteria
* Patients with any Grade 4 Division of AIDS toxicity (except for lipids and asymptomatic glucose elevations will not be included in this trial. * Patients being treated with another investigational product or in another clinical trial, except the lersivirine parent protocols will not be included in this trial.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With Plasma Human Immunodeficiency Virus - 1 (HIV-1) Ribonucleic Acid (RNA) Level <50 Copies/mL at 144 Weeks From Day 1 of the Parent Protocol | 144 Weeks from Day 1 of the parent protocol | Number of participants with HIV-1 RNA level \<50 copies/mL plasma was summarized at 48 weeks i.e. 144 weeks from Day 1 of the parent protocol. Roche Amplicor HIV-1 Monitor assay was used to measure the HIV-1 RNA level. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in CD4+ Lymphocyte Counts (Absolute) at 144 Weeks From Day 1 of the Parent Protocol | 144 Weeks from Day 1 of the parent protocol | Participant's immunological status assessed by CD4+ lymphocyte count (absolute and percentage) at 48 weeks (ie, 144 weeks from Day 1 of the parent protocol) |
| Change From Baseline in CD4+ Lymphocyte Counts (Percentage) at 144 Weeks From Day 1 of the Parent Protocol | 144 Weeks from Day 1 of the parent protocol | Participant's immunological status assessed by CD4+ lymphocyte count (absolute and percentage) at 48 weeks (ie, 144 weeks from Day 1 of the parent protocol) |
| Number of Participants With Plasma HIV-1 RNA Level <50 Copies/mL up to Week 208 | Up to Week 208 | Number of participants with HIV-1 RNA level \<50 copies/mL plasma was summarized at last visit. Abbott RealTime HIV-1 assay was used to measure the HIV-1 RNA level. |
| Change From Baseline in CD4+ Lymphocyte Counts (Percentage) at 192 Weeks From Day 1 of the Parent Protocol | 192 Weeks from Day 1 of the parent protocol | Participant's immunological status assessed by CD4+ lymphocyte count (absolute and percentage) at 192 weeks from Day 1 of the parent protocol. |
| Virology Analysis Participant Accountability From Week 96 Through Study Termination | Week 96 through study termination | Virology analysis included virus susceptibility (phenotype and genotype)to a standard panel of approved antiretrovirals as determined by the Monogram Biosciences PhenoSense GT assay. Below analysis table included the following parameters: 1. protocol-defined treatment failure was defined as an increase in HIV-1 RNA to detectable levels (≥50 copies/mL) on 2 consecutive measurements, the second measurement taken no more than 14 days after the first measurement); 2. Treatment failure: treatment failure (both virologic and non-virologic) was defined as a subject who met the protocol-defined treatment failure criterion or discontinued from the study; 3. NRTI or NNRTI resistance mutations: nucleoside reverse transcriptase inhibitor or lersivirine-associated resistance-associated mutations (RAM) based on the International AIDS Society-USA (IAS-USA) RAM guidelines; 4. 'with result' meant an analyzed sample returned genotypic result or phenotypic result or both. |
| Change From Baseline in CD4+ Lymphocyte Counts (Absolute) at 192 Weeks From Day 1 of the Parent Protocol | 192 Weeks from Day 1 of the parent protocol | Participant's immunological status assessed by CD4+ lymphocyte count (absolute and percentage) at 192 weeks from Day 1 of the parent protocol. |
Countries
Australia, Brazil, Canada, Italy, Mexico, Poland, South Africa, Switzerland, United Kingdom
Participant flow
Recruitment details
Participants who had completed 96 weeks of treatment with lersivirine in the A5271015 parent study were enrolled in this extension study. One participant from a second parent study (A5271022) was initially enrolled in Study A5271037, but later discontinued from A5271037.
Pre-assignment details
Participants were required to have plasma HIV-1 ribonucleic acid (RNA) \<50 copies/mL at Week 84 of the parent protocol. Of 108 participants screened in the parent protocol A5271015, 47, 43, and 18 participants from the lersivirine 500 mg, lersivirine 750 mg, and efavirenz 600 mg groups, respectively, were enrolled in Study A5271037.
Participants by arm
| Arm | Count |
|---|---|
| Lersivirine (LRV) 500 mg Participants received LRV 500 mg orally once daily (QD). In addition participants received treatment with tenofovir disoproxil fumarate (TDF) 300 mg/emtricitabine (FTC) 200 mg orally QD | 47 |
| LRV 750 mg Participants received LRV 750 mg orally QD. In addition participants received treatment with tenofovir disoproxil fumarate (TDF) 300 mg/emtricitabine (FTC) 200 mg orally QD | 43 |
| Efavirenz (EFV) 600 mg Participants received EFV 600 mg orally QD. In addition participants received treatment with tenofovir disoproxil fumarate (TDF) 300 mg/emtricitabine (FTC) 200 mg orally QD | 18 |
| Total | 108 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Overall Study | Adverse Event | 1 | 1 | 0 |
| Overall Study | Death | 0 | 1 | 0 |
| Overall Study | Discontinued due to termination of study | 40 | 39 | 13 |
| Overall Study | Lack of Efficacy | 3 | 0 | 0 |
| Overall Study | Lost to Follow-up | 1 | 0 | 2 |
| Overall Study | Pregnancy | 0 | 0 | 2 |
| Overall Study | Withdrawal by Subject | 2 | 2 | 1 |
Baseline characteristics
| Characteristic | LRV 750 mg | Efavirenz (EFV) 600 mg | Lersivirine (LRV) 500 mg | Total |
|---|---|---|---|---|
| Age, Continuous | 35.8 Years STANDARD_DEVIATION 8.7 | 38.5 Years STANDARD_DEVIATION 7.8 | 36.6 Years STANDARD_DEVIATION 8.4 | 36.6 Years STANDARD_DEVIATION 8.4 |
| Age, Customized 18 - 44 Years | 37 Participants | 14 Participants | 41 Participants | 92 Participants |
| Age, Customized < 18 Years | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Customized 45 - 64 Years | 6 Participants | 4 Participants | 6 Participants | 16 Participants |
| Age, Customized >= 65 Years | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Sex: Female, Male Female | 11 Participants | 8 Participants | 10 Participants | 29 Participants |
| Sex: Female, Male Male | 32 Participants | 10 Participants | 37 Participants | 79 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — |
| other Total, other adverse events | 30 / 47 | 35 / 43 | 15 / 18 |
| serious Total, serious adverse events | 6 / 47 | 5 / 43 | 0 / 18 |
Outcome results
Number of Participants With Plasma Human Immunodeficiency Virus - 1 (HIV-1) Ribonucleic Acid (RNA) Level <50 Copies/mL at 144 Weeks From Day 1 of the Parent Protocol
Number of participants with HIV-1 RNA level \<50 copies/mL plasma was summarized at 48 weeks i.e. 144 weeks from Day 1 of the parent protocol. Roche Amplicor HIV-1 Monitor assay was used to measure the HIV-1 RNA level.
Time frame: 144 Weeks from Day 1 of the parent protocol
Population: All participants enrolled in this protocol constituted the analysis population associated with each of the parent protocols and all available data were used for efficacy analyses.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Lersivirine (LRV) 500 mg | Number of Participants With Plasma Human Immunodeficiency Virus - 1 (HIV-1) Ribonucleic Acid (RNA) Level <50 Copies/mL at 144 Weeks From Day 1 of the Parent Protocol | 40 Participants |
| LRV 750 mg | Number of Participants With Plasma Human Immunodeficiency Virus - 1 (HIV-1) Ribonucleic Acid (RNA) Level <50 Copies/mL at 144 Weeks From Day 1 of the Parent Protocol | 40 Participants |
| Efavirenz (EFV) 600 mg | Number of Participants With Plasma Human Immunodeficiency Virus - 1 (HIV-1) Ribonucleic Acid (RNA) Level <50 Copies/mL at 144 Weeks From Day 1 of the Parent Protocol | 16 Participants |
Change From Baseline in CD4+ Lymphocyte Counts (Absolute) at 144 Weeks From Day 1 of the Parent Protocol
Participant's immunological status assessed by CD4+ lymphocyte count (absolute and percentage) at 48 weeks (ie, 144 weeks from Day 1 of the parent protocol)
Time frame: 144 Weeks from Day 1 of the parent protocol
Population: All participants enrolled in this protocol constituted the analysis population associated with each of the parent protocols and all available data were used for efficacy analyses. Last observation carried forward (LOCF) was used to impute missing values.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lersivirine (LRV) 500 mg | Change From Baseline in CD4+ Lymphocyte Counts (Absolute) at 144 Weeks From Day 1 of the Parent Protocol | 293 cells/uL | Standard Deviation 206 |
| LRV 750 mg | Change From Baseline in CD4+ Lymphocyte Counts (Absolute) at 144 Weeks From Day 1 of the Parent Protocol | 302 cells/uL | Standard Deviation 163 |
| Efavirenz (EFV) 600 mg | Change From Baseline in CD4+ Lymphocyte Counts (Absolute) at 144 Weeks From Day 1 of the Parent Protocol | 303 cells/uL | Standard Deviation 163 |
Change From Baseline in CD4+ Lymphocyte Counts (Absolute) at 192 Weeks From Day 1 of the Parent Protocol
Participant's immunological status assessed by CD4+ lymphocyte count (absolute and percentage) at 192 weeks from Day 1 of the parent protocol.
Time frame: 192 Weeks from Day 1 of the parent protocol
Population: Analyses included all enrolled participants. Week 192 data are presented, as Week 208 had few participants. For participants who discontinued prematurely, LOCF was used to impute values for post discontinuation visits. Participants who discontinued due to termination of the program were not included in the analysis for the post termination visits.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lersivirine (LRV) 500 mg | Change From Baseline in CD4+ Lymphocyte Counts (Absolute) at 192 Weeks From Day 1 of the Parent Protocol | 308 cells/uL | Standard Deviation 191 |
| LRV 750 mg | Change From Baseline in CD4+ Lymphocyte Counts (Absolute) at 192 Weeks From Day 1 of the Parent Protocol | 304 cells/uL | Standard Deviation 159 |
| Efavirenz (EFV) 600 mg | Change From Baseline in CD4+ Lymphocyte Counts (Absolute) at 192 Weeks From Day 1 of the Parent Protocol | 300 cells/uL | Standard Deviation 220 |
Change From Baseline in CD4+ Lymphocyte Counts (Percentage) at 144 Weeks From Day 1 of the Parent Protocol
Participant's immunological status assessed by CD4+ lymphocyte count (absolute and percentage) at 48 weeks (ie, 144 weeks from Day 1 of the parent protocol)
Time frame: 144 Weeks from Day 1 of the parent protocol
Population: All participants enrolled in this protocol constituted the analysis population associated with each of the parent protocols and all available data were used for efficacy analyses. LOCF was used to impute missing values.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lersivirine (LRV) 500 mg | Change From Baseline in CD4+ Lymphocyte Counts (Percentage) at 144 Weeks From Day 1 of the Parent Protocol | 13 Percentage | Standard Deviation 6 |
| LRV 750 mg | Change From Baseline in CD4+ Lymphocyte Counts (Percentage) at 144 Weeks From Day 1 of the Parent Protocol | 13 Percentage | Standard Deviation 5 |
| Efavirenz (EFV) 600 mg | Change From Baseline in CD4+ Lymphocyte Counts (Percentage) at 144 Weeks From Day 1 of the Parent Protocol | 13 Percentage | Standard Deviation 6 |
Change From Baseline in CD4+ Lymphocyte Counts (Percentage) at 192 Weeks From Day 1 of the Parent Protocol
Participant's immunological status assessed by CD4+ lymphocyte count (absolute and percentage) at 192 weeks from Day 1 of the parent protocol.
Time frame: 192 Weeks from Day 1 of the parent protocol
Population: Analyses included all enrolled participants. Week 192 data are presented as Week 208 had few participants. For participants who discontinued prematurely, LOCF was used to impute values for post discontinuation visits. Participants who discontinued due to termination of the program were not included in the analysis for the post termination visits.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Lersivirine (LRV) 500 mg | Change From Baseline in CD4+ Lymphocyte Counts (Percentage) at 192 Weeks From Day 1 of the Parent Protocol | 13 Percentage | Standard Deviation 6 |
| LRV 750 mg | Change From Baseline in CD4+ Lymphocyte Counts (Percentage) at 192 Weeks From Day 1 of the Parent Protocol | 15 Percentage | Standard Deviation 6 |
| Efavirenz (EFV) 600 mg | Change From Baseline in CD4+ Lymphocyte Counts (Percentage) at 192 Weeks From Day 1 of the Parent Protocol | 12 Percentage | Standard Deviation 6 |
Number of Participants With Plasma HIV-1 RNA Level <50 Copies/mL up to Week 208
Number of participants with HIV-1 RNA level \<50 copies/mL plasma was summarized at last visit. Abbott RealTime HIV-1 assay was used to measure the HIV-1 RNA level.
Time frame: Up to Week 208
Population: Analyses included all enrolled participants. Last visit used the last available visit of each participant. Discontinued from study, lost to follow-up, or missing HIV-1 RNA level data at last visit were considered to have HIV-1 RNA levels \>=50 copies/mL. Participants discontinued due to program termination were not considered as discontinuations.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Lersivirine (LRV) 500 mg | Number of Participants With Plasma HIV-1 RNA Level <50 Copies/mL up to Week 208 | 39 Participants |
| LRV 750 mg | Number of Participants With Plasma HIV-1 RNA Level <50 Copies/mL up to Week 208 | 38 Participants |
| Efavirenz (EFV) 600 mg | Number of Participants With Plasma HIV-1 RNA Level <50 Copies/mL up to Week 208 | 13 Participants |
Virology Analysis Participant Accountability From Week 96 Through Study Termination
Virology analysis included virus susceptibility (phenotype and genotype)to a standard panel of approved antiretrovirals as determined by the Monogram Biosciences PhenoSense GT assay. Below analysis table included the following parameters: 1. protocol-defined treatment failure was defined as an increase in HIV-1 RNA to detectable levels (≥50 copies/mL) on 2 consecutive measurements, the second measurement taken no more than 14 days after the first measurement); 2. Treatment failure: treatment failure (both virologic and non-virologic) was defined as a subject who met the protocol-defined treatment failure criterion or discontinued from the study; 3. NRTI or NNRTI resistance mutations: nucleoside reverse transcriptase inhibitor or lersivirine-associated resistance-associated mutations (RAM) based on the International AIDS Society-USA (IAS-USA) RAM guidelines; 4. 'with result' meant an analyzed sample returned genotypic result or phenotypic result or both.
Time frame: Week 96 through study termination
Population: The virology analysis set included only evaluable participants i.e. those having samples with valid genotypic or phenotypic susceptibility testing results and HIV-1 RNA \>500 copies/mL. However, samples with observed emergence of resistance-associated mutations and HIV-1 RNA level ≤500 copies/mL or missing HIV-1 RNA level, were also noted.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Lersivirine (LRV) 500 mg | Virology Analysis Participant Accountability From Week 96 Through Study Termination | Treatment failure (TF) | 8 Participants |
| Lersivirine (LRV) 500 mg | Virology Analysis Participant Accountability From Week 96 Through Study Termination | Protocol defined treatment failure | 4 Participants |
| Lersivirine (LRV) 500 mg | Virology Analysis Participant Accountability From Week 96 Through Study Termination | TF analysed - HIV-1 RNA >500 c/mL | 1 Participants |
| Lersivirine (LRV) 500 mg | Virology Analysis Participant Accountability From Week 96 Through Study Termination | TF analysed - HIV-1 RNA >500 c/mL with result | 1 Participants |
| Lersivirine (LRV) 500 mg | Virology Analysis Participant Accountability From Week 96 Through Study Termination | TF analysed - HIV-1 RNA <= 500 c/mL | 5 Participants |
| Lersivirine (LRV) 500 mg | Virology Analysis Participant Accountability From Week 96 Through Study Termination | TF analysed - HIV-1 RNA <= 500 c/mL with result | 2 Participants |
| Lersivirine (LRV) 500 mg | Virology Analysis Participant Accountability From Week 96 Through Study Termination | NRTI or NNRTI resistance mutations | 0 Participants |
| LRV 750 mg | Virology Analysis Participant Accountability From Week 96 Through Study Termination | NRTI or NNRTI resistance mutations | 0 Participants |
| LRV 750 mg | Virology Analysis Participant Accountability From Week 96 Through Study Termination | TF analysed - HIV-1 RNA >500 c/mL | 0 Participants |
| LRV 750 mg | Virology Analysis Participant Accountability From Week 96 Through Study Termination | TF analysed - HIV-1 RNA <= 500 c/mL with result | 1 Participants |
| LRV 750 mg | Virology Analysis Participant Accountability From Week 96 Through Study Termination | TF analysed - HIV-1 RNA >500 c/mL with result | 0 Participants |
| LRV 750 mg | Virology Analysis Participant Accountability From Week 96 Through Study Termination | TF analysed - HIV-1 RNA <= 500 c/mL | 2 Participants |
| LRV 750 mg | Virology Analysis Participant Accountability From Week 96 Through Study Termination | Treatment failure (TF) | 5 Participants |
| LRV 750 mg | Virology Analysis Participant Accountability From Week 96 Through Study Termination | Protocol defined treatment failure | 3 Participants |
| Efavirenz (EFV) 600 mg | Virology Analysis Participant Accountability From Week 96 Through Study Termination | TF analysed - HIV-1 RNA <= 500 c/mL | 2 Participants |
| Efavirenz (EFV) 600 mg | Virology Analysis Participant Accountability From Week 96 Through Study Termination | Protocol defined treatment failure | 0 Participants |
| Efavirenz (EFV) 600 mg | Virology Analysis Participant Accountability From Week 96 Through Study Termination | TF analysed - HIV-1 RNA >500 c/mL | 0 Participants |
| Efavirenz (EFV) 600 mg | Virology Analysis Participant Accountability From Week 96 Through Study Termination | Treatment failure (TF) | 5 Participants |
| Efavirenz (EFV) 600 mg | Virology Analysis Participant Accountability From Week 96 Through Study Termination | NRTI or NNRTI resistance mutations | 0 Participants |
| Efavirenz (EFV) 600 mg | Virology Analysis Participant Accountability From Week 96 Through Study Termination | TF analysed - HIV-1 RNA >500 c/mL with result | 0 Participants |
| Efavirenz (EFV) 600 mg | Virology Analysis Participant Accountability From Week 96 Through Study Termination | TF analysed - HIV-1 RNA <= 500 c/mL with result | 0 Participants |