The Dolutegravir Antiretroviral Mono-Therapy for HIV Trial

NCT02401828 | Completed Phase 4

• 1 other identifier: NL51858.078.14
• Study Type: interventional
• Target: 134
• Locations: 1 country
• Sites: 1

Brief Summary

48-week open label randomized phase IV investigator initiated intervention study. The purpose of this study is to evaluate whether HIV-1 suppression can be maintained by DTG monotherapy in HIV-1 infected, virologically suppressed patients on cART. 104 adults fulfilling the in and exclusion criteria and on stable cART will be randomized over 2 investigational arms. The first arm will contain the direct switch population. This population will switch directly from stable cART to Dolutegravir mono-therapy on baseline visit. The second arm will contain the delayed-switch population. This group will switch from stable cART to Dolutegravir monotherapy 24 weeks after baseline visit. The main goal is to investigate if Dolutegravir mono-therapy could be non-inferior to cART in virological suppressed HIV-1 infected adults. If a interim analysis (performed when 40 patients on dolutegravir monotherapy have passed week 12) shows that it is safe to continue the study, an additional 30 patients will be included on top of the 104 patients needed for the primary endpoint analysis. In contrast to the primary endpoint population, these additional 30 patients will have a CD4 nadir \<200 but a CD4 \>350 at the time of the screening visit. Besides that, these 30 patients will have to fulfill all other in and exclusion criteria of the primary endpoint population (specifically a viral load never \>100.000). These 30 patients are part of a pilot study looking at the possibility to broaden the eligible population in a future larger randomized clinical trial.

Conditions

Human Immunodeficiency Virus

Outcome Measures

Primary Outcomes (1)

• Efficacy of dolutegravir monotherapy in maintaining virological suppression in the on-treatment population

  HIV-RNA \<200c/ml at week 24 after baseline

  24 weeks

Secondary Outcomes (12)

• Time to loss of virological response (TLOVR) in the OT population

  1 week

• Efficacy of dolutegravir monotherapy in maintaining virological suppression in the entire study population (ITT)

  24 weeks

• Efficacy of dolutegravir monotherapy in maintaining virological suppression in the on-treatment population

  48 weeks

• Evaluate safety of Dolutegravir monotherapy (Acquired resistance & Adverse Events according to CDC 4.0)

  60 weeks

• Evaluate the evolution of CD4 associated HIV-1 reservoir

  48 weeks

Study Arms (2)

Group A - Direct Switch

EXPERIMENTAL

Direct switch from cART to Dolutegravir mono-therapy at baseline. Dolutegravir single tablet 50mg QD, once a day. Duration = 48 weeks

Drug: Dolutegravir

Group B - Delayed Switch

EXPERIMENTAL

Delayed switch from cART to Dolutegravir mono-therapy at week 24 from baseline. Dolutegravir single tablet 50mg QD, once a day. Duration = 48 weeks

Drug: Dolutegravir

Interventions

Dolutegravir DRUG

Switch from combination antiretroviral therapy to dolutegravir monotherapy

Also known as: Tivicay, S/GSK1349572

Group A - Direct Switch; Group B - Delayed Switch

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Documented HIV-1 positive by ELISA or Western Blot or Plasma HIV-RNA \>1000 c/ml.
• years or older.
• HIV-RNA ≤50 copies/mL for ≥24 weeks.
• Historical baseline HIV-RNA plasma load \<100.000 c/ml
• CD4 count nadir pre-cART ≥200 cells/mm3
• Not on strong UGT1A1 or CYP3A4 inducing agents as stated in DTG SPC.
• General medical condition does not interfere with trial procedures (on investigators' discretion)
• Females should have no plans of becoming pregnant during the next 18 months after the baseline visit
• Females are eligible if:
• They do not plan to become pregnant during the study
• Negative screening pregnancy test and uses one of the following methods: 1.Abstinence from penile/vaginal intercourse during the study; 2.Double barrier contraceptive methods 1 of which must be condom.

You may not qualify if:

• Previous virological failure on any ART.
• Patient without documented anti-HBs antibodies.
• Subjects positive for hepatitis B at screening (HBsAg+).
• Any documented genotypic HIV-1 resistance with at least low-level resistance according to stanford HIV drug resistance database
• No record of the historical baseline plasma viral load available
• Subjects with concomitant CDC-C opportunistic infections within 90 days of screening.
• Subjects with history of allergy to INI.
• Subjects with creatinine clearance \<50mL/min according to CKD-EPI.
• Subjects with hepatic impairment of at least Child-Pugh B.
• Exposure to experimental drug or experimental HIV-1 vaccine within 90 days of start of DTG.
• Screening ALT \>5x ULN or ALT\>3xULN and bilirubin \>2 ULN.
• Patient (man or woman) planning or hoping to conceive a child/become pregnant during the study
• Patients who cannot take DTG 2 hours before or 6 hours after antacids, calciumcarbonate or iron supplements.

Sponsors & Collaborators

• Erasmus Medical Center: lead

Study Sites (1)

Erasmus Medical Center

Rotterdam, South Holland, 3000 CA, Netherlands

Location

Related Publications (2)

• Wijting IEA, Lungu C, Rijnders BJA, van der Ende ME, Pham HT, Mesplede T, Pas SD, Voermans JJC, Schuurman R, van de Vijver DAMC, Boers PHM, Gruters RA, Boucher CAB, van Kampen JJA. HIV-1 Resistance Dynamics in Patients With Virologic Failure to Dolutegravir Maintenance Monotherapy. J Infect Dis. 2018 Jul 24;218(5):688-697. doi: 10.1093/infdis/jiy176.

  PMID: 29617822 DERIVED

• Wijting I, Rokx C, Boucher C, van Kampen J, Pas S, de Vries-Sluijs T, Schurink C, Bax H, Derksen M, Andrinopoulou ER, van der Ende M, van Gorp E, Nouwen J, Verbon A, Bierman W, Rijnders B. Dolutegravir as maintenance monotherapy for HIV (DOMONO): a phase 2, randomised non-inferiority trial. Lancet HIV. 2017 Dec;4(12):e547-e554. doi: 10.1016/S2352-3018(17)30152-2. Epub 2017 Oct 26.

  PMID: 29107562 DERIVED

MeSH Terms

Conditions

Acquired Immunodeficiency Syndrome

Interventions

dolutegravir

Condition Hierarchy (Ancestors)

HIV Infections; Blood-Borne Infections; Communicable Diseases; Infections; Sexually Transmitted Diseases, Viral; Sexually Transmitted Diseases; Lentivirus Infections; Retroviridae Infections; RNA Virus Infections; Virus Diseases; Slow Virus Diseases; Genital Diseases; Urogenital Diseases; Immunologic Deficiency Syndromes; Immune System Diseases

Study Officials

• Bart Rijnders, MD, PhD

  Erasmus Medical Center

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: phase 4
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: MD, PhD

Study Record Dates

• First Submitted: March 19, 2015
• First Posted: March 30, 2015
• Study Start: March 1, 2015
• Primary Completion: June 1, 2017
• Study Completion: July 1, 2017
• Last Updated: January 28, 2020

Record last verified: 2020-01

Locations

NL (1)