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Multicentric Open-label Study of Switch From Abacavir/Lamivudine Fixed Dose Combination Plus Nevirapine to Abacavir/Lamivudine/Dolutegravir in Virologically Suppressed HIV-1 Infected Adults (SWAD) (SWAD)

Primary Purpose

HIV-1 Infection

Status
Completed
Phase
Phase 2
Locations
France
Study Type
Interventional
Intervention
Abacavir/Lamivudine/Dolutegravir
Sponsored by
Nantes University Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for HIV-1 Infection focused on measuring HIV-1 infection, Nevirapine, Dolutegravir, Anti-retroviral agents

Eligibility Criteria

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

Inclusion Criteria:

  • Patient with confirmed HIV-1 infection (HIV antibody positive confirmation prior to screening)
  • Age ≥ 18 years
  • Written informed consent
  • Male patient or non-pregnant, non-lactating female patient
  • On antiretroviral treatment with nevirapine (400 mg per day) plus abacavir/lamivudine for more than 6 months; Nevirapine 400 mg/day being administered as either 1 x 200 mg IR x 2/day or 2 x 200 mg IR qd or 1 x 400 mg XR qd
  • No history of prior virologic failure on antiretroviral therapy
  • HIV-1 RNA < 50 copies/ml for more than 1 year,
  • No major IAS-USA nucleoside reverse transcriptase inhibitors or integrase inhibitors resistance mutations on genotypic testing on last plasma sample with HIV-1 RNA > 500 c/mL (if available)
  • HLA-B*5701 negative test
  • Subjects covered by Health Insurance

Exclusion Criteria:

  • Woman of child-bearing potential without effective contraception method. Pregnant or breastfeeding woman.
  • Woman expecting to conceive during the study period
  • HIV-2 co-infection
  • Any prior exposure to integrase inhibitor(s)
  • Plasma HIV-1 RNA > 50 c/mL in the past year
  • Creatinine clearance < 60 ml/mn (estimated glomerular filtration rate according to the MDRD equation),
  • Alkaline phosphatase, ASAT or ALAT ≥ 5 times the upper limit of the norm (ULN)
  • Patient with history of decompensated liver disease
  • Any major IAS-USA mutation conferring resistance to one or more of reverse transcriptase or integrase inhibitors on any historical plasma genotype if available. Any previous genotype result is valid, with no time limit, as long as the original test result is documented.
  • Mycobacteriosis under treatment
  • Malignancy requiring chemotherapy or radiotherapy
  • Positive HBs Ag
  • HCV infection for which specific treatment is ongoing or planned during the study
  • Known hypersensitivity to one of the trial drugs, the metabolites or formulation excipients
  • Concomitant therapy with antacids or H2 antagonists
  • Contraindicated concomitant treatment
  • Anticipated non-compliance with the protocol
  • Participation in another clinical trial with an on-going exclusion period at screening
  • Subject under legal guardianship or incapacitation
  • Subject, who in the opinion of the investigator, is unable to complete the study period

Sites / Locations

  • La Roche-sur-Yon Hospital
  • Nantes University Hospital

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Abacavir/Lamivudine/Dolutegravir

Arm Description

Patients switched from their ongoing treatment of ABC/3TC + NVP to ABC/3TC/DTG.

Outcomes

Primary Outcome Measures

Percentage of patients with plasma HIV-1 RNA < 50 copies/mL at week 12

Secondary Outcome Measures

Percentage of patients with Plasma HIV-1 RNA < 50 copies/ml at W24
Percentage of patients with Plasma HIV-1 RNA < 50 copies/ml at W48
Percentage of patients with undetectable plasma viral load (< 1 copies/ml or signal not detected) at W12
Number of patients with undetectable plasma viral load (< 1 copies/ml or signal not detected) at W24
Number of patients with undetectable plasma viral load (< 1 copies/ml or signal not detected) at W36
Number of patients with undetectable plasma viral load (< 1 copies/ml or signal not detected) at W48
Percentage of patients with adverse event of any Grade over 12 weeks
Percentage of patients with adverse event of Grade 3 or 4 over 48 weeks
CD4 and CD8 measurement
Changes in CD4 and CD8 counts over 48 weeks
Serum creatinine and GFR (MDRD) measurement
Changes in serum creatinine, and GFR (MDRD) from W2 to W48
Urinary albumine:creatinine ratio measurement
Change in urinary albumine:creatinine ratio over 48 weeks
Fasting lipids measurement
Changes in fasting lipids over 48 weeks
Plasma concentration of NVP between Week 0 (W0) and Week 2 (W2)
The mean plasma concentration of nevirapine is measured between W0 and W2 (D0, W1, W2)
Plasma concentration of dolutegravir between W0 and W12
The mean plasma concentration of dolutegravir is measured between W0 and W12 (W1, W2, W4, W12)
CD14 and usCRP measurement over 48 weeks
Changes in sCD14 and usCRP over 48 weeks (stored plasma)
Evaluation of patient's satisfaction with HIVTSQs and HIVTSQc questionnaires
Patient's satisfaction, evaluated with self-administered questionnaires HIVTSQs and HIVTSQc
Plasma concentration of DTG on 24h at D0 and Week 2
24h PK parameters of DTG (D0, after 5 days of combination of ABC/3TC + NVP + DTG) with and without NVP (D14)

Full Information

First Posted
February 18, 2014
Last Updated
February 19, 2016
Sponsor
Nantes University Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT02067767
Brief Title
Multicentric Open-label Study of Switch From Abacavir/Lamivudine Fixed Dose Combination Plus Nevirapine to Abacavir/Lamivudine/Dolutegravir in Virologically Suppressed HIV-1 Infected Adults (SWAD)
Acronym
SWAD
Official Title
Phase 2 Multicentric Open-label Study of Switch From Abacavir/Lamivudine Fixed Dose Combination Plus Nevirapine to Abacavir/Lamivudine/Dolutegravir in Virologically Suppressed HIV-1 Infected Adults
Study Type
Interventional

2. Study Status

Record Verification Date
February 2015
Overall Recruitment Status
Completed
Study Start Date
February 2014 (undefined)
Primary Completion Date
December 2015 (Actual)
Study Completion Date
December 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Nantes University Hospital

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Abacavir/Lamivudine + Nevirapine (ABC/3TC + NVP) is a very effective and well tolerable regimen on the long-term. However this regimen comprises 2 pills per day. Abacavir/Lamivudine/Dolutegravir (ABC/3TC/DTG) offers simplification with a single pill per day with no food constraints, Dolutegravir (DTG) having the advantage over Nevirapine (NVP) of high potency, higher genetic barrier to resistance, with a very good safety profile. The objective of this study is to evaluate the virologic safety (maintenance of virologic suppression) after switching from ABC/3TC + NVP to ABC/3TC/DTG in 50 HIV-1 infected adults with prolonged HIV RNA suppression on ABC/3TC + NVP, as well as clinical and laboratory safety. Because nevirapine is a strong inducer of hepatic enzymes, pharmacocinetic (PK) assessment will be performed in all patients in the first weeks after switch and 24-hours PK in a subset of 10 patients after 5 days of DTG addition to current regimen, before switching to ABC/3TC/DTG.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
HIV-1 Infection
Keywords
HIV-1 infection, Nevirapine, Dolutegravir, Anti-retroviral agents

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
53 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Abacavir/Lamivudine/Dolutegravir
Arm Type
Experimental
Arm Description
Patients switched from their ongoing treatment of ABC/3TC + NVP to ABC/3TC/DTG.
Intervention Type
Drug
Intervention Name(s)
Abacavir/Lamivudine/Dolutegravir
Intervention Description
At Day 1 (D1): group 1 will switch their ongoing treatment of ABC/3TC + NVP to ABC/3TC/DTG ; group 2 will continue NVP and switch ABC/3TC to ABC/3TC/DTG for 6 days (D-5 to D0), then stop NVP from D1.
Primary Outcome Measure Information:
Title
Percentage of patients with plasma HIV-1 RNA < 50 copies/mL at week 12
Time Frame
Week 12
Secondary Outcome Measure Information:
Title
Percentage of patients with Plasma HIV-1 RNA < 50 copies/ml at W24
Time Frame
Week 24
Title
Percentage of patients with Plasma HIV-1 RNA < 50 copies/ml at W48
Time Frame
Week 48
Title
Percentage of patients with undetectable plasma viral load (< 1 copies/ml or signal not detected) at W12
Time Frame
Week 12
Title
Number of patients with undetectable plasma viral load (< 1 copies/ml or signal not detected) at W24
Time Frame
Week 24
Title
Number of patients with undetectable plasma viral load (< 1 copies/ml or signal not detected) at W36
Time Frame
Week 36
Title
Number of patients with undetectable plasma viral load (< 1 copies/ml or signal not detected) at W48
Time Frame
Week 48
Title
Percentage of patients with adverse event of any Grade over 12 weeks
Time Frame
Week 12
Title
Percentage of patients with adverse event of Grade 3 or 4 over 48 weeks
Time Frame
Week 48
Title
CD4 and CD8 measurement
Description
Changes in CD4 and CD8 counts over 48 weeks
Time Frame
Week 48
Title
Serum creatinine and GFR (MDRD) measurement
Description
Changes in serum creatinine, and GFR (MDRD) from W2 to W48
Time Frame
Week 48
Title
Urinary albumine:creatinine ratio measurement
Description
Change in urinary albumine:creatinine ratio over 48 weeks
Time Frame
Week 48
Title
Fasting lipids measurement
Description
Changes in fasting lipids over 48 weeks
Time Frame
Week 48
Title
Plasma concentration of NVP between Week 0 (W0) and Week 2 (W2)
Description
The mean plasma concentration of nevirapine is measured between W0 and W2 (D0, W1, W2)
Time Frame
Week 2
Title
Plasma concentration of dolutegravir between W0 and W12
Description
The mean plasma concentration of dolutegravir is measured between W0 and W12 (W1, W2, W4, W12)
Time Frame
Week 12
Title
CD14 and usCRP measurement over 48 weeks
Description
Changes in sCD14 and usCRP over 48 weeks (stored plasma)
Time Frame
Week 48
Title
Evaluation of patient's satisfaction with HIVTSQs and HIVTSQc questionnaires
Description
Patient's satisfaction, evaluated with self-administered questionnaires HIVTSQs and HIVTSQc
Time Frame
Week 48
Title
Plasma concentration of DTG on 24h at D0 and Week 2
Description
24h PK parameters of DTG (D0, after 5 days of combination of ABC/3TC + NVP + DTG) with and without NVP (D14)
Time Frame
Week 2

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patient with confirmed HIV-1 infection (HIV antibody positive confirmation prior to screening) Age ≥ 18 years Written informed consent Male patient or non-pregnant, non-lactating female patient On antiretroviral treatment with nevirapine (400 mg per day) plus abacavir/lamivudine for more than 6 months; Nevirapine 400 mg/day being administered as either 1 x 200 mg IR x 2/day or 2 x 200 mg IR qd or 1 x 400 mg XR qd No history of prior virologic failure on antiretroviral therapy HIV-1 RNA < 50 copies/ml for more than 1 year, No major IAS-USA nucleoside reverse transcriptase inhibitors or integrase inhibitors resistance mutations on genotypic testing on last plasma sample with HIV-1 RNA > 500 c/mL (if available) HLA-B*5701 negative test Subjects covered by Health Insurance Exclusion Criteria: Woman of child-bearing potential without effective contraception method. Pregnant or breastfeeding woman. Woman expecting to conceive during the study period HIV-2 co-infection Any prior exposure to integrase inhibitor(s) Plasma HIV-1 RNA > 50 c/mL in the past year Creatinine clearance < 60 ml/mn (estimated glomerular filtration rate according to the MDRD equation), Alkaline phosphatase, ASAT or ALAT ≥ 5 times the upper limit of the norm (ULN) Patient with history of decompensated liver disease Any major IAS-USA mutation conferring resistance to one or more of reverse transcriptase or integrase inhibitors on any historical plasma genotype if available. Any previous genotype result is valid, with no time limit, as long as the original test result is documented. Mycobacteriosis under treatment Malignancy requiring chemotherapy or radiotherapy Positive HBs Ag HCV infection for which specific treatment is ongoing or planned during the study Known hypersensitivity to one of the trial drugs, the metabolites or formulation excipients Concomitant therapy with antacids or H2 antagonists Contraindicated concomitant treatment Anticipated non-compliance with the protocol Participation in another clinical trial with an on-going exclusion period at screening Subject under legal guardianship or incapacitation Subject, who in the opinion of the investigator, is unable to complete the study period
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
François RAFFI, Pr
Organizational Affiliation
Nantes University Hospital
Official's Role
Study Chair
Facility Information:
Facility Name
La Roche-sur-Yon Hospital
City
La Roche-sur-Yon
Country
France
Facility Name
Nantes University Hospital
City
Nantes
Country
France

12. IPD Sharing Statement

Citations:
PubMed Identifier
26271944
Citation
Dailly E, Allavena C, Gregoire M, Reliquet V, Bouquie R, Billaud E, Hernando H, Bouchez S, Deslandes G, Hall N, Jolliet P, Raffi F. Influence of nevirapine administration on the pharmacokinetics of dolutegravir in patients infected with HIV-1. J Antimicrob Chemother. 2015 Dec;70(12):3307-10. doi: 10.1093/jac/dkv245. Epub 2015 Aug 13.
Results Reference
derived

Learn more about this trial

Multicentric Open-label Study of Switch From Abacavir/Lamivudine Fixed Dose Combination Plus Nevirapine to Abacavir/Lamivudine/Dolutegravir in Virologically Suppressed HIV-1 Infected Adults (SWAD)

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