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The Effect of Ixazomib on the Latent HIV Reservoir

Primary Purpose

Human Immunodeficiency Virus (HIV)

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Ixazomib 1 MG
Ixazomib 2 MG
Ixazomib 3 MG
Ixazomib 4 MG
Sponsored by
Mayo Clinic
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Human Immunodeficiency Virus (HIV) focused on measuring Antiretroviral Therapy (ART)

Eligibility Criteria

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

Inclusion Criteria:

  • The following laboratory values obtained <=14 days prior to registration.
  • ANC ≥ LLN (lower limit of normal) and ≤ULN (upper limit of normal), Hgb ≥ LLN and ≤ULN, PLT ≥ LLN and ≤ULN
  • Total bilirubin ≤ULN and the direct bilirubin must be ≤ ULN; AST <1.5 x ULN and ALT <1.5 x ULN
  • Creatinine <2.0 x ULN and an estimated creatinine clearance > 60 ml/min
  • HIV infection with suppressed viral replication on at least 3 active drug ART for at least 6 months
  • Suppressed viral replication is defined by plasma HIV viral load <20copies/mL.
  • Patient must have HIV viral load <20 copies/ml on two occasions at least 3 months apart.
  • In the opinion of the treating physician, patients must have available other regimens likely to suppress HIV should their current regimen fail.
  • Male or female patients age >=18 years
  • A plasma HIV RNA viral load demonstrating a measure of <20 copies/mL within 30 days prior to study initiation.
  • CD4 count >500 cells/mm3 within 30 days prior to study enrollment
  • Females must have a negative pregnancy test prior to receiving the 1st dose of ixazomib and be postmenopausal for at least 1 year before the screen visit, or surgically sterile,
  • Male patients, even if surgically sterilized (ie, status post-vasectomy), must agree to one of the following:

    • Agree to practice effective barrier contraception AND a second method of contraception for female partners of childbearing potential during the entire study treatment period and through 90 days after the last dose of ixazomib,
    • OR
    • Agree to practice true abstinence when this is in line with the preferred and usual lifestyle of the subject. (Periodic abstinence (eg, calendar, ovulation, symptothermal, post-ovulation methods] and withdrawal are not acceptable methods of contraception.)
    • AND
    • Agree to forego sperm donation for the same period as above.

Exclusion Criteria:

  • The following laboratory values obtained <=14 days prior to registration.

    • ANC < LLN and >ULN, Hgb < LLN and >ULN, PLT < LLN and >ULN
    • Total bilirubin >ULN or the direct bilirubin is > ULN; AST >1.5 x ULN or AST >1.5 x ULN
    • Creatinine >=2.0 x ULN or an estimated creatinine clearance <=60mL/min
  • Diagnosed and treated for a malignancy within 5 years before randomization, or previously diagnosed with a malignancy and have any evidence of residual disease. Patients with nonmelanoma skin cancer or carcinoma in situ of any type are not excluded if they have undergone complete resection
  • Any infection except HIV (excluding benign conditions that is unlikely to be affected or modulated by treatment with ixazomib, e.g. stye or furuncle), or treatment with anti-infective agents within 14 days of enrollment.
  • Pregnant women
  • Women of childbearing potential and Nursing women
  • Men who are unwilling to use a condom (even if they have undergone a prior vasectomy) while having intercourse, while taking the drug and for 90 days after stopping ixazomib.
  • Any history of peripheral neuropathy, or peripheral neuropathy detected during the screening period.
  • Major surgery within 14 days before study registration
  • Systemic treatment with strong CYP3A inducers (rifampin, rifapentine, rifabutin,carbamazepine, phenytoin, phenobarbital), or use of St. John's wort.
  • Evidence of current uncontrolled cardiovascular conditions, including serious cardiac arrhythmias, congestive heart failure, angina, or myocardial infarction within the past 6 months.
  • QTc > 450 milliseconds (msec) for men and >470 milliseconds for women (83) on a 12 lead ECG obtained during the Screening period.
  • Known hepatitis B DNA positive status and/or HBsAg positive and/or HBeAg positive, or active hepatitis C replication (HCV RNA positive) or currently on hepatitis C treatment.
  • Known history of cirrhosis or active liver inflammation, including "fatty liver" or non-alcohol steatohepatitis (NASH).
  • Any serious medical or psychiatric illness that could, in the investigator's opinion, potentially interfere with the completion of treatment according to this protocol.
  • Known allergy to any of the study medications, their analogues or excipients in the various formulations.
  • Any other recent or concurrent medical condition that, in the Investigator's opinion, would impose any risk to the patient
  • Known GI disease or GI procedure that could interfere with the oral absorption or tolerance of ixazomib including difficulty swallowing.
  • Participation in other clinical trials, including those with other investigational agents not included in this trial, within 30 days of the start of this trial and throughout the duration of this trial.

Sites / Locations

  • Mayo Clinic

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Experimental

Experimental

Experimental

Arm Label

Ixazomib 1 mg

Ixazomib 2 mg

Ixazomib 3 mg

Ixazomib 4 mg

Arm Description

Cohort A: Patients will receive ixazomib 1mg 3 times monthly for 12 weeks, then weekly for 12 weeks.

Cohort B: Patients will receive ixazomib 2mg 3 times monthly for 12 weeks, then weekly for 12 weeks.

Cohort C: Patients will receive ixazomib 3 mg 3 times monthly for 12 weeks, then weekly for 12 weeks.

Cohort D: Patients will receive ixazomib 4mg 3 times monthly for 12 weeks, then weekly for 12 weeks.

Outcomes

Primary Outcome Measures

Incidence of Treatment-Emergent Adverse Events
Number of treatment-emergent adverse events experienced by subjects as defined by NCI Common Terminology Criteria for Adverse Events (CTCAE) version 4.0

Secondary Outcome Measures

Cell Associated HIV DNA in CD4 T Cell Subsets
HIV copies per million CD4 T cells
Culturable HIV by Quantitative Viral Outgrowth Assay
Infectious units per million CD4 T cells
Absolute CD4 T Cell Count
Cells per microliter
Absolute CD8 T Cell Count
Cells per microliter
CD4/CD8 Ratio
CD4/CD8 T cell count ratio

Full Information

First Posted
October 24, 2016
Last Updated
December 8, 2021
Sponsor
Mayo Clinic
Collaborators
Takeda
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1. Study Identification

Unique Protocol Identification Number
NCT02946047
Brief Title
The Effect of Ixazomib on the Latent HIV Reservoir
Official Title
Pilot Study of Ixazomib to Reduce the Number of HIV DNA Positive Lymphoid Cells
Study Type
Interventional

2. Study Status

Record Verification Date
December 2021
Overall Recruitment Status
Completed
Study Start Date
March 20, 2017 (Actual)
Primary Completion Date
August 19, 2019 (Actual)
Study Completion Date
August 19, 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Mayo Clinic
Collaborators
Takeda

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The primary purpose of the trial is to determine the safety and tolerability of ixazomib in HIV infected patients on antiretroviral therapy. The secondary purpose is to determine the effect of ixazomib on the size of the HIV reservoir.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Human Immunodeficiency Virus (HIV)
Keywords
Antiretroviral Therapy (ART)

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Sequential Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
17 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Ixazomib 1 mg
Arm Type
Experimental
Arm Description
Cohort A: Patients will receive ixazomib 1mg 3 times monthly for 12 weeks, then weekly for 12 weeks.
Arm Title
Ixazomib 2 mg
Arm Type
Experimental
Arm Description
Cohort B: Patients will receive ixazomib 2mg 3 times monthly for 12 weeks, then weekly for 12 weeks.
Arm Title
Ixazomib 3 mg
Arm Type
Experimental
Arm Description
Cohort C: Patients will receive ixazomib 3 mg 3 times monthly for 12 weeks, then weekly for 12 weeks.
Arm Title
Ixazomib 4 mg
Arm Type
Experimental
Arm Description
Cohort D: Patients will receive ixazomib 4mg 3 times monthly for 12 weeks, then weekly for 12 weeks.
Intervention Type
Drug
Intervention Name(s)
Ixazomib 1 MG
Other Intervention Name(s)
Ninlaro
Intervention Description
1 mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 1 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.
Intervention Type
Drug
Intervention Name(s)
Ixazomib 2 MG
Other Intervention Name(s)
Ninlaro
Intervention Description
2mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 2 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.
Intervention Type
Drug
Intervention Name(s)
Ixazomib 3 MG
Other Intervention Name(s)
Ninlaro
Intervention Description
3 mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 3 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.
Intervention Type
Drug
Intervention Name(s)
Ixazomib 4 MG
Other Intervention Name(s)
Ninlaro
Intervention Description
4 mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 4 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.
Primary Outcome Measure Information:
Title
Incidence of Treatment-Emergent Adverse Events
Description
Number of treatment-emergent adverse events experienced by subjects as defined by NCI Common Terminology Criteria for Adverse Events (CTCAE) version 4.0
Time Frame
7 months
Secondary Outcome Measure Information:
Title
Cell Associated HIV DNA in CD4 T Cell Subsets
Description
HIV copies per million CD4 T cells
Time Frame
24 weeks
Title
Culturable HIV by Quantitative Viral Outgrowth Assay
Description
Infectious units per million CD4 T cells
Time Frame
24 weeks
Title
Absolute CD4 T Cell Count
Description
Cells per microliter
Time Frame
24 weeks
Title
Absolute CD8 T Cell Count
Description
Cells per microliter
Time Frame
24 weeks
Title
CD4/CD8 Ratio
Description
CD4/CD8 T cell count ratio
Time Frame
24 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: The following laboratory values obtained <=14 days prior to registration. ANC ≥ LLN (lower limit of normal) and ≤ULN (upper limit of normal), Hgb ≥ LLN and ≤ULN, PLT ≥ LLN and ≤ULN Total bilirubin ≤ULN and the direct bilirubin must be ≤ ULN; AST <1.5 x ULN and ALT <1.5 x ULN Creatinine <2.0 x ULN and an estimated creatinine clearance > 60 ml/min HIV infection with suppressed viral replication on at least 3 active drug ART for at least 6 months Suppressed viral replication is defined by plasma HIV viral load <20copies/mL. Patient must have HIV viral load <20 copies/ml on two occasions at least 3 months apart. In the opinion of the treating physician, patients must have available other regimens likely to suppress HIV should their current regimen fail. Male or female patients age >=18 years A plasma HIV RNA viral load demonstrating a measure of <20 copies/mL within 30 days prior to study initiation. CD4 count >500 cells/mm3 within 30 days prior to study enrollment Females must have a negative pregnancy test prior to receiving the 1st dose of ixazomib and be postmenopausal for at least 1 year before the screen visit, or surgically sterile, Male patients, even if surgically sterilized (ie, status post-vasectomy), must agree to one of the following: Agree to practice effective barrier contraception AND a second method of contraception for female partners of childbearing potential during the entire study treatment period and through 90 days after the last dose of ixazomib, OR Agree to practice true abstinence when this is in line with the preferred and usual lifestyle of the subject. (Periodic abstinence (eg, calendar, ovulation, symptothermal, post-ovulation methods] and withdrawal are not acceptable methods of contraception.) AND Agree to forego sperm donation for the same period as above. Exclusion Criteria: The following laboratory values obtained <=14 days prior to registration. ANC < LLN and >ULN, Hgb < LLN and >ULN, PLT < LLN and >ULN Total bilirubin >ULN or the direct bilirubin is > ULN; AST >1.5 x ULN or AST >1.5 x ULN Creatinine >=2.0 x ULN or an estimated creatinine clearance <=60mL/min Diagnosed and treated for a malignancy within 5 years before randomization, or previously diagnosed with a malignancy and have any evidence of residual disease. Patients with nonmelanoma skin cancer or carcinoma in situ of any type are not excluded if they have undergone complete resection Any infection except HIV (excluding benign conditions that is unlikely to be affected or modulated by treatment with ixazomib, e.g. stye or furuncle), or treatment with anti-infective agents within 14 days of enrollment. Pregnant women Women of childbearing potential and Nursing women Men who are unwilling to use a condom (even if they have undergone a prior vasectomy) while having intercourse, while taking the drug and for 90 days after stopping ixazomib. Any history of peripheral neuropathy, or peripheral neuropathy detected during the screening period. Major surgery within 14 days before study registration Systemic treatment with strong CYP3A inducers (rifampin, rifapentine, rifabutin,carbamazepine, phenytoin, phenobarbital), or use of St. John's wort. Evidence of current uncontrolled cardiovascular conditions, including serious cardiac arrhythmias, congestive heart failure, angina, or myocardial infarction within the past 6 months. QTc > 450 milliseconds (msec) for men and >470 milliseconds for women (83) on a 12 lead ECG obtained during the Screening period. Known hepatitis B DNA positive status and/or HBsAg positive and/or HBeAg positive, or active hepatitis C replication (HCV RNA positive) or currently on hepatitis C treatment. Known history of cirrhosis or active liver inflammation, including "fatty liver" or non-alcohol steatohepatitis (NASH). Any serious medical or psychiatric illness that could, in the investigator's opinion, potentially interfere with the completion of treatment according to this protocol. Known allergy to any of the study medications, their analogues or excipients in the various formulations. Any other recent or concurrent medical condition that, in the Investigator's opinion, would impose any risk to the patient Known GI disease or GI procedure that could interfere with the oral absorption or tolerance of ixazomib including difficulty swallowing. Participation in other clinical trials, including those with other investigational agents not included in this trial, within 30 days of the start of this trial and throughout the duration of this trial.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Nathan Cummins, MD
Organizational Affiliation
Mayo Clinic
Official's Role
Principal Investigator
Facility Information:
Facility Name
Mayo Clinic
City
Rochester
State/Province
Minnesota
ZIP/Postal Code
55905
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Links:
URL
https://www.mayo.edu/research/clinical-trials
Description
Mayo Clinic Clinical Trials

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The Effect of Ixazomib on the Latent HIV Reservoir

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