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Efficacy and Tolerance of the Switch From Enfuvirtine to Raltegravir in Antiretroviral Therapy Regimen in HIV Patients With Undetectable Viral Load (EASIER)

Primary Purpose

HIV Infections

Status
Completed
Phase
Phase 3
Locations
France
Study Type
Interventional
Intervention
FTC/TDF + EFV or LPV/R +T20
FTC/TDF + EFV or LPV/R
Sponsored by
French National Agency for Research on AIDS and Viral Hepatitis
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for HIV Infections focused on measuring HIV-1 infection, enfuvirtide, raltegravir, treatment experienced

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Chronic HIV-1 infection
  • Treatment with a well-tolerated combination of antiretroviral drugs unchanged for at least 3 months, including enfuvirtide
  • Absence of any uncontrolled opportunistic disease
  • No restrictions on CD4 lymphocyte levels
  • Plasma HIV-1 RNA below 400 copies per ml for at least 3 months (at least two consecutive tests below 400 copies per ml prior to inclusion in the study, not including that on W -4)
  • For women of childbearing age, use of mechanical contraception during any sexual intercourse and negative pregnancy test (plasma ß HCG) at W -4

Exclusion Criteria:

  • HIV-2 infection
  • Plasma HIV-1 RNA levels above 400 copies/ml on one occasion during the 3 months prior to screening (or the pre-inclusion visit at W -4)
  • Poor compliance with antiretroviral therapy current at W -4
  • Current treatment with an investigational drug (except cohort ATU)
  • Patient previously treated with an integrase inhibitor in the context of a clinical study
  • Woman who is pregnant or likely to become so, is breastfeeding or refuses to use contraception
  • Multiple drug therapy ongoing or necessary in the foreseeable future for Kaposi's disease or lymphoma
  • Treatment with interferon ongoing or necessary in the foreseeable future for chronic hepatitis B or C
  • Acute hepatitis whatever the case, or decompensated cirrhosis
  • Current treatment with interferon, interleukin or anti-HIV vaccine
  • Any condition (including, but not limited to, the consumption of alcohol or drugs) which might, in the investigator's opinion, compromise the safety of treatment and/or patient compliance with the protocol
  • Significant biological abnormalities (hemoglobin below 8g per dl, polynuclear neutrophils below 750 per mm3, platelets below 50,000 per mm3, serum creatinine above 3 times the level deemed normal by the laboratory (N), ASAT or ALAT above 5N, serum lipase above 2N) and total bilirubin above 2N (except if the patient is receiving atazanavir or indinavir)
  • Concomitant treatments including one or more compounds interacting with UGT1A1

    • anti-infective agents: rifampicin/rifampin
    • psychotropic/anti-epileptic drugs: phenytoin, phenobarbital.

Sites / Locations

  • Service des maladies infectieuses et tropicales Hopital Saint Louis

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Intensification arm

Standard arm

Arm Description

emtricitabine/TDF + efavirenz or lopinavir/ritonavir + enfuvirtide

emtricitabine/TDF + efavirenz or lopinavir/ritonavir

Outcomes

Primary Outcome Measures

comparison of the proportions of virologic failure, defined as two consecutive pVL above 400 cp per ml, through 24 weeks in enfuvirtide-maintained arm versus raltegravir arm

Secondary Outcome Measures

comparison of time to onset of virologic failure
proportions of pts with pVL under 50 and 400 cp per ml respectively at week 24 and week 48 ;
plasma viral mutations in the event of virologic failure, compared to HIV-DNA archived mutations at baseline;
change in CD4 levels
incidence of HIV-related events
drug plasma and male genital tract pharmacokinetics;
incidence and type of adverse events, including adverse reactions
proportions of discontinuing allocated treatment strategy
quality of life and adherence
morphological and metabolic disorders outcome

Full Information

First Posted
March 29, 2007
Last Updated
November 6, 2012
Sponsor
French National Agency for Research on AIDS and Viral Hepatitis
Collaborators
Merck Sharp & Dohme LLC
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1. Study Identification

Unique Protocol Identification Number
NCT00454337
Brief Title
Efficacy and Tolerance of the Switch From Enfuvirtine to Raltegravir in Antiretroviral Therapy Regimen in HIV Patients With Undetectable Viral Load
Acronym
EASIER
Official Title
Randomized Non-inferiority Study Comparing a Strategy Maintaining Current Enfuvirtide-based Antiretroviral Therapy to a Strategy Replacing Enfuvirtide by an Integrase Inhibitor (Raltegravir) in HIV-1 Infected Subjects With Plasma Hiv-1 RNA Levels Below 400 Copies Per ml.ANRS 138 EASIER
Study Type
Interventional

2. Study Status

Record Verification Date
November 2012
Overall Recruitment Status
Completed
Study Start Date
May 2007 (undefined)
Primary Completion Date
September 2008 (Actual)
Study Completion Date
September 2008 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
French National Agency for Research on AIDS and Viral Hepatitis
Collaborators
Merck Sharp & Dohme LLC

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Switching from enfuvirtide to raltegravir in the treatment of HIV-infected patients who sustain viral suppression with a combination therapy including enfuvirtide (or : with an enfuvirtide-based combination therapy)
Detailed Description
In patients who have failed under the three main classes of antiretroviral agents (NRTI, NNRTI and PI) and in whom the control of viral replication in the plasma has ultimately been achieved with enfuvirtide, the aim is to sustain this virological success for as long as possible to thus enable satisfactory immune reconstitution, avoid further accumulation of viral mutations conferring resistance to the drugs and protect the patient from the risk of opportunistic disease and death. Indeed, enfuvirtide is the lead compound in the new class of antiretroviral drugs which inhibit the fusion of HIV-1 virus with its target cell. Its in vivo efficacy was demonstrated during the pivotal studies TORO 1 and 2. Despite its efficacy, maintaining long-term treatment with enfuvirtide is nonetheless difficult for patients because of the constraints related to twice-daily subcutaneous parenteral injections. Furthermore, these subcutaneous injections are associated with inflammatory reactions at the injection site in 98 per cent of patients, without any reduction in frequency or severity over time. It is thus critical for patients who are well controlled by enfuvirtide to be able to simplify their treatment by replacing enfuvirtide with another active compound taken by mouth, which would enable maintenance of the virological response and acceptable safety in patients who have usually failed under the three main classes of antiretroviral drugs. A new antiviral compound, viral integrase inhibitor called raltegravir, could be proposed instead of enfuvirtide.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
HIV Infections
Keywords
HIV-1 infection, enfuvirtide, raltegravir, treatment experienced

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
170 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Intensification arm
Arm Type
Experimental
Arm Description
emtricitabine/TDF + efavirenz or lopinavir/ritonavir + enfuvirtide
Arm Title
Standard arm
Arm Type
Active Comparator
Arm Description
emtricitabine/TDF + efavirenz or lopinavir/ritonavir
Intervention Type
Drug
Intervention Name(s)
FTC/TDF + EFV or LPV/R +T20
Intervention Description
emtricitabine 200mg/TDF 300mg (1 pill per day) + efavirenz 600mg (1 pill per day) or lopinavir/ritonavir (3 pills twice a day) + enfuvirtide 90mg twice a day
Intervention Type
Drug
Intervention Name(s)
FTC/TDF + EFV or LPV/R
Intervention Description
emtricitabine 200mg/TDF 300mg (1 pill per day) + efavirenz 600mg (1 pill per day) or lopinavir/ritonavir (3 pills twice a day)
Primary Outcome Measure Information:
Title
comparison of the proportions of virologic failure, defined as two consecutive pVL above 400 cp per ml, through 24 weeks in enfuvirtide-maintained arm versus raltegravir arm
Time Frame
W24
Secondary Outcome Measure Information:
Title
comparison of time to onset of virologic failure
Time Frame
W24 and W48
Title
proportions of pts with pVL under 50 and 400 cp per ml respectively at week 24 and week 48 ;
Time Frame
W24 & W48
Title
plasma viral mutations in the event of virologic failure, compared to HIV-DNA archived mutations at baseline;
Time Frame
virologic failure
Title
change in CD4 levels
Time Frame
between W0 and W48
Title
incidence of HIV-related events
Time Frame
between W0 and W48
Title
drug plasma and male genital tract pharmacokinetics;
Time Frame
W24 & W48
Title
incidence and type of adverse events, including adverse reactions
Time Frame
between W0 & W48
Title
proportions of discontinuing allocated treatment strategy
Time Frame
between W0 & W48
Title
quality of life and adherence
Time Frame
W4, W12, W24 and W48
Title
morphological and metabolic disorders outcome
Time Frame
between W0 & W48

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Chronic HIV-1 infection Treatment with a well-tolerated combination of antiretroviral drugs unchanged for at least 3 months, including enfuvirtide Absence of any uncontrolled opportunistic disease No restrictions on CD4 lymphocyte levels Plasma HIV-1 RNA below 400 copies per ml for at least 3 months (at least two consecutive tests below 400 copies per ml prior to inclusion in the study, not including that on W -4) For women of childbearing age, use of mechanical contraception during any sexual intercourse and negative pregnancy test (plasma ß HCG) at W -4 Exclusion Criteria: HIV-2 infection Plasma HIV-1 RNA levels above 400 copies/ml on one occasion during the 3 months prior to screening (or the pre-inclusion visit at W -4) Poor compliance with antiretroviral therapy current at W -4 Current treatment with an investigational drug (except cohort ATU) Patient previously treated with an integrase inhibitor in the context of a clinical study Woman who is pregnant or likely to become so, is breastfeeding or refuses to use contraception Multiple drug therapy ongoing or necessary in the foreseeable future for Kaposi's disease or lymphoma Treatment with interferon ongoing or necessary in the foreseeable future for chronic hepatitis B or C Acute hepatitis whatever the case, or decompensated cirrhosis Current treatment with interferon, interleukin or anti-HIV vaccine Any condition (including, but not limited to, the consumption of alcohol or drugs) which might, in the investigator's opinion, compromise the safety of treatment and/or patient compliance with the protocol Significant biological abnormalities (hemoglobin below 8g per dl, polynuclear neutrophils below 750 per mm3, platelets below 50,000 per mm3, serum creatinine above 3 times the level deemed normal by the laboratory (N), ASAT or ALAT above 5N, serum lipase above 2N) and total bilirubin above 2N (except if the patient is receiving atazanavir or indinavir) Concomitant treatments including one or more compounds interacting with UGT1A1 anti-infective agents: rifampicin/rifampin psychotropic/anti-epileptic drugs: phenytoin, phenobarbital.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Nathalie De Castro, MD
Organizational Affiliation
AP-HP Hopital Saint Louis Paris
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Jean M Molina, MD
Organizational Affiliation
AP-HP Hopital saint Louis Paris
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Jean P Aboulker, MD
Organizational Affiliation
INSERM SC10 Villejuif France
Official's Role
Study Chair
Facility Information:
Facility Name
Service des maladies infectieuses et tropicales Hopital Saint Louis
City
Paris
ZIP/Postal Code
75010
Country
France

12. IPD Sharing Statement

Citations:
PubMed Identifier
21576452
Citation
Goldwirt L, Braun J, de Castro N, Charreau I, Barrail-Tran A, Delaugerre C, Raffi F, Lascoux-Combe C, Aboulker JP, Taburet AM, Molina JM. Switch from enfuvirtide to raltegravir lowers plasma concentrations of darunavir and tipranavir: a pharmacokinetic substudy of the EASIER-ANRS 138 trial. Antimicrob Agents Chemother. 2011 Jul;55(7):3613-5. doi: 10.1128/AAC.01827-10. Epub 2011 May 16.
Results Reference
result
PubMed Identifier
19995925
Citation
Barau C, Delaugerre C, Braun J, de Castro N, Furlan V, Charreau I, Gerard L, Lascoux-Combe C, Molina JM, Taburet AM. High concentration of raltegravir in semen of HIV-infected men: results from a substudy of the EASIER-ANRS 138 trial. Antimicrob Agents Chemother. 2010 Feb;54(2):937-9. doi: 10.1128/AAC.01261-09. Epub 2009 Dec 7.
Results Reference
result
PubMed Identifier
20683319
Citation
Delaugerre C, Charreau I, Braun J, Nere ML, de Castro N, Yeni P, Ghosn J, Aboulker JP, Molina JM, Simon F; ANRS 138 study group. Time course of total HIV-1 DNA and 2-long-terminal repeat circles in patients with controlled plasma viremia switching to a raltegravir-containing regimen. AIDS. 2010 Sep 24;24(15):2391-5. doi: 10.1097/QAD.0b013e32833d214c.
Results Reference
result
PubMed Identifier
21126958
Citation
Boulet T, Pavie J, Charreau I, Braun J, Reynes J, Morlat P, Piroth L, Spire B, Molina JM, Aboulker JP; Easier-Anrs 138 Study Group. Impact on health-related quality of life of a switch from enfuvirtide to raltegravir among multidrug-resistant HIV-1-infected patients: a randomized open-label trial (EASIER-ANRS 138). HIV Clin Trials. 2010 Sep-Oct;11(5):283-93. doi: 10.1310/hct1105-283.
Results Reference
result
PubMed Identifier
21326075
Citation
Gallien S, Delaugerre C, Charreau I, Braun J, Boulet T, Barrail-Tran A, de Castro N, Molina JM, Kuritzkes DR. Emerging integrase inhibitor resistance mutations in raltegravir-treated HIV-1-infected patients with low-level viremia. AIDS. 2011 Mar 13;25(5):665-9. doi: 10.1097/QAD.0b013e3283445834.
Results Reference
result
PubMed Identifier
21712241
Citation
Gallien S, Braun J, Delaugerre C, Charreau I, Reynes J, Jeanblanc F, Verdon R, de Truchis P, May T, Madelaine-Chambrin I, Aboulker JP, Molina JM; EASIER ANRS 138 Study Group. Efficacy and safety of raltegravir in treatment-experienced HIV-1-infected patients switching from enfuvirtide-based regimens: 48 week results of the randomized EASIER ANRS 138 trial. J Antimicrob Chemother. 2011 Sep;66(9):2099-106. doi: 10.1093/jac/dkr269. Epub 2011 Jun 28.
Results Reference
result
PubMed Identifier
22416781
Citation
Delaugerre C, Braun J, Charreau I, Delarue S, Nere ML, de Castro N, May T, Marchou B, Simon F, Molina JM, Aboulker JP; ANRS 138-EASIER study group. Comparison of resistance mutation patterns in historical plasma HIV RNA genotypes with those in current proviral HIV DNA genotypes among extensively treated patients with suppressed replication. HIV Med. 2012 Oct;13(9):517-25. doi: 10.1111/j.1468-1293.2012.01002.x. Epub 2012 Mar 14.
Results Reference
result
PubMed Identifier
27042193
Citation
de Castro N, Braun J, Charreau I, Lafeuillade A, Viard JP, Allavena C, Aboulker JP, Molina JM; EASIER ANRS 138 study group. Incidence and risk factors for liver enzymes elevations in highly treatment-experienced patients switching from enfuvirtide to raltegravir: a sub-study of the ANRS-138 EASIER trial. AIDS Res Ther. 2016 Apr 2;13:17. doi: 10.1186/s12981-016-0101-3. eCollection 2016.
Results Reference
derived
PubMed Identifier
19757993
Citation
De Castro N, Braun J, Charreau I, Pialoux G, Cotte L, Katlama C, Raffi F, Weiss L, Meynard JL, Yazdanpanah Y, Delaugerre C, Madelaine-Chambrin I, Aboulker JP, Molina JM; EASIER ANRS 138 study group. Switch from enfuvirtide to raltegravir in virologically suppressed multidrug-resistant HIV-1-infected patients: a randomized open-label trial. Clin Infect Dis. 2009 Oct 15;49(8):1259-67. doi: 10.1086/605674.
Results Reference
derived

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Efficacy and Tolerance of the Switch From Enfuvirtine to Raltegravir in Antiretroviral Therapy Regimen in HIV Patients With Undetectable Viral Load

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