HIV/AIDS
Conditions
Keywords
HIV, AIDS, Monoclonal antibodies, Neutralizing antibodies, Analytical treatment interruption
Brief summary
This is a Phase 1/2a open label study to evaluate the safety, tolerability, pharmacokinetics and anti-viral activity of PGT121, VRC07-523LS and PGDM1400 for HIV prevention and therapy.
Detailed description
This is a Phase 1/2a open label study to evaluate the safety, tolerability, pharmacokinetics and anti-viral efficacy of PGT121, VRC07-523LS and PGDM1400 antibodies for HIV prevention and therapy. PGT121, VRC07-523LS and PGDM1400 are recombinant human IgG1 monoclonal antibodies that target a V3 glycan-dependent epitope region of the HIV envelope protein and the CD4 binding site (CD4bs) of the HIV envelope protein. PGT121, VRC07-523LS and PGDM1400 mAbs were chosen for this study because of their potency, their ability to neutralize a wide array of cross-clade HIV viruses in a complementary pattern, and their proven antiviral activity in animal studies, e.g., their capacity to robustly prevent and treat simian-human immunodeficiency virus (SHIV) in rhesus monkeys. The potency and breadth of PGT121, VRC07-523LS and PGDM1400 raise the possibility that monoclonal antibodies may be effective for HIV prophylaxis at low doses and against global viruses. Neutralization sensitivity profiles are complementary; and the combination of these mAbs with unique epitope specificities will provide experience assessing the potential additive, synergistic, or antagonistic properties of two bNAbs given sequentially.
Interventions
PGT121 + VRC07-523LS, dose 30 mg/kg each, given intravenously
PGT121 + VRC07-523LS + PGDM1400, dose 20 mg/kg each, given intravenously
Sponsors
Study design
Eligibility
Inclusion criteria
1. Willing to comply with the requirements of the protocol and available for follow-up for the planned duration of the study. 2. In the opinion of the Principal Investigator or designee and based on Assessment of Informed Consent Understanding results, has understood the information provided and potential impact and/or risks linked to IV infusion and participation in the trial; written informed consent will be obtained from the volunteer before any study-related procedures are performed. 3. All volunteers born female engaging in sexual activity that could lead to pregnancy must commit to use an effective method of contraception from the day of the first IV infusion of investigational product until 6 months following the final investigational product administration 4. All sexually active volunteers born male, regardless of reproductive potential, must be willing to consistently use an effective method of contraception from the day of investigational product administration until at least 6 months following the final investigational product administration to avoid exposure of partners to investigational product in ejaculate, and to prevent conception with female partners. 5. All volunteers born female must be willing to undergo urine pregnancy tests at time points indicated in the Schedule of Procedures and must test negative prior to investigational product administration. 6. All volunteers born female must agree not to donate eggs (ova, oocytes) for the purpose of assisted reproduction until 6 months after the final investigational product administration. Volunteers born male must agree not to donate sperm until 6 months after final investigational product administration. 7. Willing to forgo donations of blood and/or any other tissues, including bone marrow, during the study and, for those HIV-uninfected volunteers who test HIV-positive due to investigational product administration, until the anti-HIV antibody titers become undetectable. Specific inclusion criteria for HIV-uninfected volunteers (Group 1): 1. Healthy male or female, including transgender, volunteers, as assessed by a medical history, physical exam, and laboratory test 2. At least 18 years of age on the day of screening and has not reached his or her 51st birthday on the day of signing the Informed Consent Document 3. Willing to undergo HIV testing, risk reduction counseling and receive HIV test results 4. Low risk for HIV infection for 12 months prior to study participation and willing to maintain low-risk behavior for the duration of the trial Specific inclusion criteria for HIV-infected volunteers (Group 2): 1. At least 18 years of age on the day of screening and has not reached his or her 66th birthday on the day of signing the Informed Consent Document 2. Confirmed HIV-1 infection (HIV Ab+ or HIV RNA+) by documentation in the medical records or in-clinic HIV testing 3. CD4 ≥ 400 cells/µl 4. On antiretroviral therapy for a minimum of 24 months, with plasma HIV-1 RNA levels of \< 50 copies/ml for at least 12 months as documented in the medical records, and with a viral load \< 50 copies / ml at time of screening (within 56 days prior to IP administration). ART must not have been initiated during the acute phase of the infection as suggested by the available medical history and laboratory data from the time of the diagnosis. Note: ART is defined as a regimen including \> 2 compounds, e.g., 2x nucleoside reverse transcriptase inhibitors plus either non-nucleoside reverse transcriptase inhibitor or protease inhibitor or integrase inhibitor. 5. If on an NNRTI-based regimen, willing to switch to an integrase inhibitor containing regimen for 4 weeks prior to discontinuing ART 6. No history of AIDS-defining illness within the past 5 years 7. No history of CD4 nadir \<200 cells/ul 8. Under care of an HIV healthcare provider 5.6
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pharmacokinetics - Area under the concentration decay curve (AUC) | Up to 44 weeks | Pharmacokinetics following IV infusion of PGT121, VRC07-523LS and PGDM1400 in HIV-uninfected and HIV-infected adults: • Area under the concentration decay curve (AUC) |
| Safety and Tolerability - Proportion of volunteers with moderate or greater reactogenicity | 3 days post infusion for each infusion | Proportion of volunteers with moderate or greater reactogenicity (i.e., solicited adverse events) for 3 days following each IV infusion of PGT121, VRC07-523LS and PGDM1400 as assessed using the Division of AIDS (DAIDS) Table for Grading the Severity of Adult and Pediatric Adverse Events, Version 2.1, July 2017, or the Common Terminology Criteria for Adverse Events (CTCAE,) Version 5.0 27 November 2017 (for reactogenicity observed within the first 24 hours post-infusion.) |
| Safety and Tolerability - Proportion of volunteers with adverse events (AEs) | 56 days | Proportion of volunteers with adverse events (AEs), including safety laboratory (biochemical, hematological) parameters, during the 56 days following IV infusion of PGT121, VRC07-523LS and PGDM1400 that are moderate or greater, and/or considered related to PGT121 and/or VRC07-523LS and/or PGDM1400 as assessed using the Division of AIDS (DAIDS) Table for Grading the Severity of Adult and Pediatric Adverse Events, Corrected Version 2.1, July 2017, or the Common Terminology Criteria for Adverse Events (CTCAE,) Version 5.0 27 November 2017 (for reactogenicity observed within the first 24 hours post-infusion.) |
| Safety and Tolerability - Proportion of volunteers with serious adverse events (SAEs) | Up to 44 weeks | Proportion of volunteers with serious adverse events (SAEs) throughout the study period following IV infusion(s) of PGT121, VRC07-523LS and PGDM1400 that are considered related to PGT121 and/or VRC07-523LS and/or PGDM1400 as assessed using the Division of AIDS (DAIDS) Table for Grading the Severity of Adult and Pediatric Adverse Events, Corrected Version 2.1, July 2017, or the Common Terminology Criteria for Adverse Events (CTCAE,) Version 5.0 27 November 2017 (for reactogenicity observed within the first 24 hours post-infusion.) |
| Pharmacokinetics - Elimination half-life (t1/2) | Up to 44 weeks | Pharmacokinetics following IV infusion of PGT121, VRC07-523LS and PGDM1400 in HIV-uninfected and HIV-infected adults: • Elimination half-life (t1/2) |
| Pharmacokinetics - Clearance (CL/F) | Up to 44 weeks | Pharmacokinetics following IV infusion of PGT121, VRC07-523LS and PGDM1400 in HIV-uninfected and HIV-infected adults: • Clearance (CL/F) |
| Pharmacokinetics - Volume of distribution (Vz/F) | Up to 44 weeks | Pharmacokinetics following IV infusion of PGT121, VRC07-523LS and PGDM1400 in HIV-uninfected and HIV-infected adults: • Volume of distribution (Vz/F) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Antiviral Activity - Proportion of volunteers who meet ART re-initiation criteria | Up to 44 weeks | Proportion of volunteers who meet ART re-initiation criteria (defined as plasma HIV-1 RNA ≥ 1000 copies/ml and/or CD4 count \< 300 cells/μl) on two consecutive measurements following ART interruption in Group 2 |
| Anti-PGDM1400 antibodies | Up to 44 weeks | Serum anti-PGDM1400 antibody titers |
| Antiviral Activity - Time to meeting ART re-initiation criteria | Up to 44 weeks | Time to meeting ART re-initiation criteria (plasma HIV-1 RNA level ≥ 1000 copies/ml, CD4+ T cell count \< 300 cells/ μl in two consecutive measurements) following ART interruption in Group 2 |
| mAb serum levels at the time of viral rebound in Group 2 | Up to 44 weeks | Serum levels of PGT121 at time of viral rebound |
| CD4+ T cell count | Up to 44 weeks | Change in CD4+ T cell count and frequency compared to baseline as measured by single platform flow cytometry in HIV-infected adults following IV infusion of PGT121, VRC07-523LS and PGDM1400. |
| Effects of PGT121, VRC07-523LS and PGDM1400 on viral escape mutations in rebound viruses | Up to 44 weeks | Phylogenetic comparison of viruses grown from PBMCs collected from volunteers while on ART to rebound viruses collected after ART interruption (Group 2) |
| Anti-PGT121 antibodies | Up to 44 weeks | Serum anti-PGT121 antibody titers |
| Anti-VRC07-523LS antibodies | Up to 44 weeks | Serum anti-VRC07-523LS antibody titers |
Countries
United States