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Doravirine/Islatravir (DOR/ISL) in Pediatric Participants With Human Immunodeficiency Virus Type 1 (HIV-1) Who Are <18 Years of Age and Weigh ≥35 kg (MK-8591A-028)

Primary Purpose

HIV-1 Infection

Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
DOR/ISL
Sponsored by
Merck Sharp & Dohme LLC
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for HIV-1 Infection

Eligibility Criteria

undefined - 17 Years (Child)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Is HIV-1 positive, is <18 years of age, and weighs ≥35 kg at screening.
  • VS Participants: Is HIV-1 positive at Screening with plasma HIV-1 RNA <50 copies/mL and has been receiving continuous, stable oral 2-drug or 3-drug combination ART ± PK booster with documented viral suppression for ≥3 months prior to providing documented informed consent/assent and has no history of prior virologic treatment failure on any past or current regimen.
  • TN Participants: Is HIV-1 positive at Screening with plasma HIV-1 RNA ≥500 copies/mL and is naive to ART defined as having received <=10 days of prior therapy with any antiretrovirals following HIV-1 diagnosis other than pre-exposure prophylaxis (PrEP) or potentially exposed person (PEP).
  • If female, is not pregnant or breastfeeding, and is either 1) not a woman of childbearing potential (WOCBP) or 2) is a WOCBP and is using acceptable contraception or is abstinent.

Exclusion Criteria:

  • Has HIV-2 infection.
  • Has hypersensitivity or other contraindication to any of the components of the study drugs as determined by the investigator.
  • Has an active diagnosis of hepatitis due to any cause, including active hepatitis B virus (HBV) infection (defined as hepatitis B surface antigen [HBsAg]-positive or HBV deoxyribonucleic acid [DNA] positive).
  • Has a history of malignancy ≤5 years prior to providing documented informed consent except for adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, or cutaneous Kaposi's sarcoma.
  • Has a history or current evidence of any condition (including active tuberculosis infection), therapy, laboratory abnormality or other circumstance (including drug or alcohol use or dependence) that might, in the opinion of the investigator, confound the results of the study or interfere with the participant's participation for the full duration of the study, such that it is not in the best interest of the participant to participate.
  • Is taking or is anticipated to require systemic immunosuppressive therapy, immune modulators, or any prohibited therapies from 45 days prior to Day 1 through the study treatment period.
  • Is currently taking long-acting cabotegravir-rilpivirine.
  • Is currently participating in or has participated in an interventional clinical study with an investigational compound or device from 45 days prior to Day 1 through the study treatment period.
  • Has a documented or known virologic resistance to DOR/ISL (DOR resistance substitutions in reverse transcriptase: V106A/M, V108I, Y188L, H221Y, P225H, F227C/L, M230I/L, L234I, P236L, or Y318F; ISL resistance substitution in reverse transcriptase: M184V/I).
  • Has exclusionary laboratory values.
  • Is female and expecting to conceive or donate eggs at any time during the study.

Sites / Locations

  • Children's National Medical Center ( Site 1816)
  • Emory Children's Center ( Site 1805)
  • Johns Hopkins University ( Site 1800)
  • Duke University ( Site 1807)
  • Azienda Ospedaliera Luigi Sacco ( Site 1300)
  • IRCCS Ospedale Pediatrico Bambino Gesu ( Site 1301)
  • Krasnoyarsk Regional Center for Prevention and Control of AIDS ( Site 1507)
  • Infectious Clinical Hospital #2 ( Site 1501)
  • FGU Republican Clinical Infectious Hospital of Roszdrav ( Site 1500)
  • Saratov Regional Clinical Center for Prophylaxis and Control of AIDS ( Site 1505)
  • Perinatal HIV Research Unit ( Site 1902)
  • Wits Reproductive Health and HIV Institute (WRHI) ( Site 1903)
  • Empilweni Services and Research Unit ( Site 1904)
  • King Edward Hospital ( Site 1900)
  • Chulalongkorn University ( Site 1602)
  • Siriraj Hospital ( Site 1601)
  • Research Institute for Health Sciences ( Site 1603)

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

DOR/ISL

Arm Description

Pediatric participants with HIV-1 infection receive DOR/ISL for 96 weeks.

Outcomes

Primary Outcome Measures

Area Under the Plasma Drug Concentration-time Curve From 0 to 24 Hours Post-dose (AUC0-24) of Islatravir (ISL)
The AUC0-24 of ISL in plasma was determined at steady state.
Maximum Plasma Concentration (Cmax) of ISL
The Cmax of ISL in plasma was determined at steady state.
Time to Reach Maximum Plasma Concentration (Tmax) of ISL
The Tmax of ISL in plasma was determined at steady state.
Apparent Plasma Terminal Half-life (t½) of ISL
The t½ of ISL in plasma was determined at steady state.
Apparent Total Clearance From Plasma (CL/F) of ISL
The CL/F of ISL from plasma was determined at steady state.
Apparent Volume of Distribution During Terminal Phase (Vz/F) of ISL
The Vz/F of ISL was determined at steady state.
AUC0-last of ISL-triphosphate (ISL-TP) in Peripheral Blood Mononuclear Cells (PBMCs)
The AUC0-24 of ISL-TP in PBMCs was determined at steady state.
Cmax of ISL-TP in PBMCs
The Cmax of ISL-TP in PBMCs was determined at steady state.
C24 of ISL-TP in PBMCs
The C24 of ISL-TP in PBMCs was determined at steady state.
Number of Participants Experiencing ≥1 Adverse Event (AE)
An AE is any untoward medical occurrence in a clinical study participant, temporally associated with the use of study intervention, whether or not considered related to the study intervention.
Number of Participants Discontinuing From Study Treatment Due to an AE
An AE is any untoward medical occurrence in a clinical study participant, temporally associated with the use of study intervention, whether or not considered related to the study intervention.

Secondary Outcome Measures

Percentage of Virologically Suppressed (VS) Participants With HIV-1 Ribonucleic Acid (RNA) ≥50 Copies/mL
The percentage of VS participants with HIV-1 RNA ≥50 copies/mL was determined at the central laboratory with an Abbott Real Time Polymerase Chain Reaction (PCR) assay with a lower limit of detection (LLOD) of 40 copies/mL.
Percentage of VS Participants With HIV-1 RNA <50 Copies/mL
The percentage of VS participants with HIV-1 RNA <50 copies/mL will be determined at the central laboratory with an Abbott Real Time PCR assay with a LLOD of 40 copies/mL.
Percentage of Treatment Naive (TN) Participants With HIV-1 RNA <50 Copies/mL
The percentage of TN participants with HIV-1 RNA <50 copies/mL will be determined at the central laboratory with an Abbott Real Time PCR assay with a LLOD of 40 copies/mL.
Change From Baseline in Cluster of Differentiation 4+ (CD4+) T-cells in VS Participants
CD4+ T-cell counts were measured by a central laboratory. Negative and positive results represent a decrease and increase, respectively, from baseline CD4+ T-cell counts.
Change From Baseline in CD4+ T-cells in TN Participants
CD4+ T-cell counts were measured by a central laboratory. Negative and positive results represent a decrease and increase, respectively, from baseline CD4+ T-cell counts.
Incidence of Viral Drug Resistance to DOR
The number of participants with viral drug resistance to DOR was determined.
Incidence of Viral Drug Resistance to ISL
The number of participants with viral drug resistance to ISL was determined.
Palatability of DOR/ISL Tablet
The palatability of the DOR/ISL tablet (whole or split) was assessed with a modified 5-point facial hedonic scale. Responses ranged from 1 ("very bad") to 5 ("very good"). Data show the number of VS and TN participants responding at each score at the designated time points.
Acceptability of DOR/ISL Tablet
The acceptability of the DOR/ISL tablet (whole or split) was assessed. Acceptability was assessed by monitoring for refusing the tablet, throwing up or spitting out the tablet, and gagging on the tablet. Data show the number of VS and TN participants responding at each score at the designated time points.

Full Information

First Posted
March 3, 2020
Last Updated
February 23, 2023
Sponsor
Merck Sharp & Dohme LLC
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1. Study Identification

Unique Protocol Identification Number
NCT04295772
Brief Title
Doravirine/Islatravir (DOR/ISL) in Pediatric Participants With Human Immunodeficiency Virus Type 1 (HIV-1) Who Are <18 Years of Age and Weigh ≥35 kg (MK-8591A-028)
Official Title
A Phase 2 Clinical Study to Evaluate the Pharmacokinetics, Safety, and Efficacy of Doravirine/Islatravir in Pediatric Participants With HIV-1 Infection Who Are Virologically Suppressed or Treatment-Naïve, Are Less Than 18 Years of Age, and Weigh Greater Than or Equal to 35 kg
Study Type
Interventional

2. Study Status

Record Verification Date
February 2023
Overall Recruitment Status
Completed
Study Start Date
November 26, 2020 (Actual)
Primary Completion Date
December 21, 2021 (Actual)
Study Completion Date
January 25, 2023 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Merck Sharp & Dohme LLC

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
This is a phase 2, single-group, multi-site, open-label study of an islatravir/doravirine (ISL/DOR, MK-8591A) fixed dose combination (FDC) for the treatment of human immunodeficiency virus type 1 (HIV-1) infection in pediatric participants who are virologically suppressed (VS) on antiretroviral therapy (ART) for ≥3 months or are treatment-naive (TN). The primary purposes of the study are 1) to examine the steady-state pharmacokinetics (PK) of ISL in plasma; 2) the steady-state PK of ISL-triphosphate (ISL-TP) in peripheral blood mononuclear cells (PBMCs); and 3) to examine the safety and tolerability of ISL/DOR.
Detailed Description
As of protocol amendment 03 (approved 08-Feb-2022), all participants have been discontinued from study therapy and will be switched to non-study antiretroviral therapy and monitored for safety. The present results cover data obtained through the cut-off date of 30-Mar-2022, and will be updated once monitoring is completed.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
HIV-1 Infection

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
DOR/ISL
Arm Type
Experimental
Arm Description
Pediatric participants with HIV-1 infection receive DOR/ISL for 96 weeks.
Intervention Type
Drug
Intervention Name(s)
DOR/ISL
Other Intervention Name(s)
MK-8591A, Doravirine/islatravir
Intervention Description
100 mg DOR/0.75 mg ISL FDC tablet taken once daily by mouth.
Primary Outcome Measure Information:
Title
Area Under the Plasma Drug Concentration-time Curve From 0 to 24 Hours Post-dose (AUC0-24) of Islatravir (ISL)
Description
The AUC0-24 of ISL in plasma was determined at steady state.
Time Frame
Pre-dose, and 0.5, 1, 2, 4, 8, 12, and 24 hours post-dose on Day 28
Title
Maximum Plasma Concentration (Cmax) of ISL
Description
The Cmax of ISL in plasma was determined at steady state.
Time Frame
Pre-dose, and 0.5, 1, 2, 4, 8, 12, and 24 hours post-dose on Day 28
Title
Time to Reach Maximum Plasma Concentration (Tmax) of ISL
Description
The Tmax of ISL in plasma was determined at steady state.
Time Frame
Pre-dose, and 0.5, 1, 2, 4, 8, 12, and 24 hours post-dose on Day 28
Title
Apparent Plasma Terminal Half-life (t½) of ISL
Description
The t½ of ISL in plasma was determined at steady state.
Time Frame
Pre-dose, and 0.5, 1, 2, 4, 8, 12, and 24 hours post-dose on Day 28
Title
Apparent Total Clearance From Plasma (CL/F) of ISL
Description
The CL/F of ISL from plasma was determined at steady state.
Time Frame
Pre-dose, and 0.5, 1, 2, 4, 8, 12, and 24 hours post-dose on Day 28
Title
Apparent Volume of Distribution During Terminal Phase (Vz/F) of ISL
Description
The Vz/F of ISL was determined at steady state.
Time Frame
Pre-dose, and 0.5, 1, 2, 4, 8, 12, and 24 hours post-dose on Day 28
Title
AUC0-last of ISL-triphosphate (ISL-TP) in Peripheral Blood Mononuclear Cells (PBMCs)
Description
The AUC0-24 of ISL-TP in PBMCs was determined at steady state.
Time Frame
Pre-dose, and 4 and 24 hours post-dose on Day 28
Title
Cmax of ISL-TP in PBMCs
Description
The Cmax of ISL-TP in PBMCs was determined at steady state.
Time Frame
Pre-dose, and 4, and 24 hours post-dose on Day 28
Title
C24 of ISL-TP in PBMCs
Description
The C24 of ISL-TP in PBMCs was determined at steady state.
Time Frame
24 hours post-dose on Day 28
Title
Number of Participants Experiencing ≥1 Adverse Event (AE)
Description
An AE is any untoward medical occurrence in a clinical study participant, temporally associated with the use of study intervention, whether or not considered related to the study intervention.
Time Frame
Up to 24 weeks
Title
Number of Participants Discontinuing From Study Treatment Due to an AE
Description
An AE is any untoward medical occurrence in a clinical study participant, temporally associated with the use of study intervention, whether or not considered related to the study intervention.
Time Frame
Up to 24 weeks
Secondary Outcome Measure Information:
Title
Percentage of Virologically Suppressed (VS) Participants With HIV-1 Ribonucleic Acid (RNA) ≥50 Copies/mL
Description
The percentage of VS participants with HIV-1 RNA ≥50 copies/mL was determined at the central laboratory with an Abbott Real Time Polymerase Chain Reaction (PCR) assay with a lower limit of detection (LLOD) of 40 copies/mL.
Time Frame
Week 24
Title
Percentage of VS Participants With HIV-1 RNA <50 Copies/mL
Description
The percentage of VS participants with HIV-1 RNA <50 copies/mL will be determined at the central laboratory with an Abbott Real Time PCR assay with a LLOD of 40 copies/mL.
Time Frame
Week 24
Title
Percentage of Treatment Naive (TN) Participants With HIV-1 RNA <50 Copies/mL
Description
The percentage of TN participants with HIV-1 RNA <50 copies/mL will be determined at the central laboratory with an Abbott Real Time PCR assay with a LLOD of 40 copies/mL.
Time Frame
Week 24
Title
Change From Baseline in Cluster of Differentiation 4+ (CD4+) T-cells in VS Participants
Description
CD4+ T-cell counts were measured by a central laboratory. Negative and positive results represent a decrease and increase, respectively, from baseline CD4+ T-cell counts.
Time Frame
Baseline (Day 1) and Week 24
Title
Change From Baseline in CD4+ T-cells in TN Participants
Description
CD4+ T-cell counts were measured by a central laboratory. Negative and positive results represent a decrease and increase, respectively, from baseline CD4+ T-cell counts.
Time Frame
Baseline (Day 1) and Week 24
Title
Incidence of Viral Drug Resistance to DOR
Description
The number of participants with viral drug resistance to DOR was determined.
Time Frame
Up to 24 weeks
Title
Incidence of Viral Drug Resistance to ISL
Description
The number of participants with viral drug resistance to ISL was determined.
Time Frame
Up to 24 weeks
Title
Palatability of DOR/ISL Tablet
Description
The palatability of the DOR/ISL tablet (whole or split) was assessed with a modified 5-point facial hedonic scale. Responses ranged from 1 ("very bad") to 5 ("very good"). Data show the number of VS and TN participants responding at each score at the designated time points.
Time Frame
Baseline (Day 1), Week 4, and Week 24
Title
Acceptability of DOR/ISL Tablet
Description
The acceptability of the DOR/ISL tablet (whole or split) was assessed. Acceptability was assessed by monitoring for refusing the tablet, throwing up or spitting out the tablet, and gagging on the tablet. Data show the number of VS and TN participants responding at each score at the designated time points.
Time Frame
Baseline (Day 1), Week 4, and Week 24

10. Eligibility

Sex
All
Maximum Age & Unit of Time
17 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Is HIV-1 positive, is <18 years of age, and weighs ≥35 kg at screening. VS Participants: Is HIV-1 positive at Screening with plasma HIV-1 RNA <50 copies/mL and has been receiving continuous, stable oral 2-drug or 3-drug combination ART ± PK booster with documented viral suppression for ≥3 months prior to providing documented informed consent/assent and has no history of prior virologic treatment failure on any past or current regimen. TN Participants: Is HIV-1 positive at Screening with plasma HIV-1 RNA ≥500 copies/mL and is naive to ART defined as having received <=10 days of prior therapy with any antiretrovirals following HIV-1 diagnosis other than pre-exposure prophylaxis (PrEP) or potentially exposed person (PEP). If female, is not pregnant or breastfeeding, and is either 1) not a woman of childbearing potential (WOCBP) or 2) is a WOCBP and is using acceptable contraception or is abstinent. Exclusion Criteria: Has HIV-2 infection. Has hypersensitivity or other contraindication to any of the components of the study drugs as determined by the investigator. Has an active diagnosis of hepatitis due to any cause, including active hepatitis B virus (HBV) infection (defined as hepatitis B surface antigen [HBsAg]-positive or HBV deoxyribonucleic acid [DNA] positive). Has a history of malignancy ≤5 years prior to providing documented informed consent except for adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, or cutaneous Kaposi's sarcoma. Has a history or current evidence of any condition (including active tuberculosis infection), therapy, laboratory abnormality or other circumstance (including drug or alcohol use or dependence) that might, in the opinion of the investigator, confound the results of the study or interfere with the participant's participation for the full duration of the study, such that it is not in the best interest of the participant to participate. Is taking or is anticipated to require systemic immunosuppressive therapy, immune modulators, or any prohibited therapies from 45 days prior to Day 1 through the study treatment period. Is currently taking long-acting cabotegravir-rilpivirine. Is currently participating in or has participated in an interventional clinical study with an investigational compound or device from 45 days prior to Day 1 through the study treatment period. Has a documented or known virologic resistance to DOR/ISL (DOR resistance substitutions in reverse transcriptase: V106A/M, V108I, Y188L, H221Y, P225H, F227C/L, M230I/L, L234I, P236L, or Y318F; ISL resistance substitution in reverse transcriptase: M184V/I). Has exclusionary laboratory values. Is female and expecting to conceive or donate eggs at any time during the study.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Medical Director
Organizational Affiliation
Merck Sharp & Dohme LLC
Official's Role
Study Director
Facility Information:
Facility Name
Children's National Medical Center ( Site 1816)
City
Washington
State/Province
District of Columbia
ZIP/Postal Code
20010
Country
United States
Facility Name
Emory Children's Center ( Site 1805)
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30322
Country
United States
Facility Name
Johns Hopkins University ( Site 1800)
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21287
Country
United States
Facility Name
Duke University ( Site 1807)
City
Durham
State/Province
North Carolina
ZIP/Postal Code
27705
Country
United States
Facility Name
Azienda Ospedaliera Luigi Sacco ( Site 1300)
City
Milano
ZIP/Postal Code
20157
Country
Italy
Facility Name
IRCCS Ospedale Pediatrico Bambino Gesu ( Site 1301)
City
Roma
ZIP/Postal Code
00165
Country
Italy
Facility Name
Krasnoyarsk Regional Center for Prevention and Control of AIDS ( Site 1507)
City
Krasnoyarsk
State/Province
Krasnoyarskiy Kray
ZIP/Postal Code
660049
Country
Russian Federation
Facility Name
Infectious Clinical Hospital #2 ( Site 1501)
City
Moscow
State/Province
Moskva
ZIP/Postal Code
105275
Country
Russian Federation
Facility Name
FGU Republican Clinical Infectious Hospital of Roszdrav ( Site 1500)
City
Saint Petersburg
State/Province
Sankt-Peterburg
ZIP/Postal Code
196645
Country
Russian Federation
Facility Name
Saratov Regional Clinical Center for Prophylaxis and Control of AIDS ( Site 1505)
City
Saratov
State/Province
Saratovskaya Oblast
ZIP/Postal Code
410009
Country
Russian Federation
Facility Name
Perinatal HIV Research Unit ( Site 1902)
City
Johannesburg
State/Province
Gauteng
ZIP/Postal Code
1864
Country
South Africa
Facility Name
Wits Reproductive Health and HIV Institute (WRHI) ( Site 1903)
City
Johannesburg
State/Province
Gauteng
ZIP/Postal Code
2000
Country
South Africa
Facility Name
Empilweni Services and Research Unit ( Site 1904)
City
Johannesburg
State/Province
Gauteng
ZIP/Postal Code
2093
Country
South Africa
Facility Name
King Edward Hospital ( Site 1900)
City
Durban
State/Province
Kwazulu-Natal
ZIP/Postal Code
4001
Country
South Africa
Facility Name
Chulalongkorn University ( Site 1602)
City
Bangkok
State/Province
Krung Thep Maha Nakhon
ZIP/Postal Code
10330
Country
Thailand
Facility Name
Siriraj Hospital ( Site 1601)
City
Bangkok
State/Province
Krung Thep Maha Nakhon
ZIP/Postal Code
10700
Country
Thailand
Facility Name
Research Institute for Health Sciences ( Site 1603)
City
Chiang Mai
ZIP/Postal Code
50200
Country
Thailand

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
http://engagezone.msd.com/doc/ProcedureAccessClinicalTrialData.pdf
IPD Sharing URL
http://engagezone.msd.com/ds_documentation.php

Learn more about this trial

Doravirine/Islatravir (DOR/ISL) in Pediatric Participants With Human Immunodeficiency Virus Type 1 (HIV-1) Who Are <18 Years of Age and Weigh ≥35 kg (MK-8591A-028)

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