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Safety and Pharmacokinetics Evaluation of Fostemsavir + (OBT) in HIV-1 Infected Children and Adolescents Who Are Failing Their cART and Have Dual- or Triple-class Antiretroviral Resistance

Primary Purpose

HIV Infections With Multi Drug Resistant Virus

Status
Recruiting
Phase
Phase 1
Locations
International
Study Type
Interventional
Intervention
Fostemsavir
Sponsored by
PENTA Foundation
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for HIV Infections With Multi Drug Resistant Virus

Eligibility Criteria

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

Inclusion Criteria:

  • Male and female HIV-1 infected paediatric participants from 6 years old and weighing at least 20 kg to less than 18 years of age.
  • Antiretroviral-experienced with documented historical or baseline resistance to one or more agents in at least two classes. All resistance has to be properly documented.
  • Failing current antiretroviral regimen with a confirmed plasma HIV-1 RNA ≥ 1000 c/mL (first value from Investigator within 6 months of screening visit, with the second value obtained from Screening labs, without a decline greater than 1 log10, and no value <1000 in between).
  • Documented resistance to at least one component of the current failing regimen per screening resistance testing.
  • Must have at least 1 fully active and available agent in 2 or more ARV classes, based on current and/or documented historical resistance testing, taking into account tolerability, and other safety concerns. At least two fully active agents must be a part of the initial OBT to be paired with FTR.
  • Girls who have reached menarche must have a negative pregnancy test at screening, not be breastfeeding, and be willing to adhere to effective methods of contraception if sexually active. All participants (male or female) have to agree with recommendations for effective contraception.

Exclusion Criteria:

Medical History and Concurrent Diseases:

  • Unable to comply with dosing requirements (to swallow solid pharmaceutical form of the investigational medicinal product)
  • Unable to comply with study visits
  • Presence of a malabsorption syndrome or other gastrointestinal dysfunction which might interfere with drug absorption or render the participant unable to take oral medication.
  • Any clinical condition (including but not limited to recreational drug use) or prior therapy that, in the opinion of the Investigator, would make the participant unsuitable for the study
  • Pregnancy and breastfeeding

Physical and Laboratory Test Findings:

  • Chronic untreated Hepatitis B virus (HBV) (however, participants with chronic treated HBV or spontaneously remitted HBV are eligible)
  • HIV-2 infection
  • Alanine aminotransferase (ALT) ≥5 times the upper limit of normal (ULN), OR ALT ≥3xULN and bilirubin ≥1.5xULN (with>35% direct bilirubin)
  • History of unstable liver disease, decompensated cirrhosis, or known biliary disorder
  • History of congestive heart failure, or congenital/acquired prolonged QT syndrome/other cardiac diseases predisposing to prolonged QTc
  • Hemoglobin < 8.0 g/dL
  • Platelets < 50,000 cells/mm3
  • Confirmed QTcF value > 450 msec, regardless of sex, at Screening or Day 1
  • Current (defined as taking the medication within 14 days of Day 1) or anticipated treatment with medication considered prohibited or restricted as per Appendix II. Certain medication will be carefully evaluated as acceptable, see Appendix II.
  • Participation in an experimental drug and/or HIV-1 vaccine trial(s) within the previous 30 days
  • Child in governmental care, e.g. child is a ward of the state. Note: This criterion does not apply if the child is officially adopted by a family/guardian.

Sites / Locations

  • The George Washington University, Children's National Health SystemRecruiting
  • Children's Healthcare of AtlantaRecruiting
  • Hospital General Mexico
  • FAM-CRU
  • King Edward VIII HospitalRecruiting
  • Rahima Moosa Mother and Child HospitalRecruiting
  • Wits Reproductive Health and HIV InstitutelRecruiting
  • PHRURecruiting
  • Hospital 12 de Octubre

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Fostemsavir

Arm Description

Fostemsavir in combination with optimized background therapy (OBT) in HIV-1 infected children and adolescents who are failing their current combination antiretroviral therapy (cART) and have dual- or triple-class ARV resistance

Outcomes

Primary Outcome Measures

Occurrence of the following events through Week 24
AUC(0-tau)
Cmax
Ctau of temsavir across weight bands

Secondary Outcome Measures

Proportion of patients with HIV-1 RNA <50 copies/mL
To evaluate the antiviral activity of fostemsavir + OBT
Change in log10 HIV-1 RNA from baseline
Occurrence of: AEs, treatment-related AEs, AEs of Grade 3 or higher, serious AEs, and AEs leading to premature study treatment discontinuation.
Occurrence of WHO 3 or 4 defining events, or death
efficacy of fostemsavir plus OBT
changes from baseline in CD4+ T cell counts and the percentage of CD4 + T-cells
Emergence of genotypic or phenotypic resistance to Temsavir and components of OBT

Full Information

First Posted
November 10, 2020
Last Updated
March 28, 2023
Sponsor
PENTA Foundation
Collaborators
ViiV Healthcare, PHPT Foundation, Hospital Universitario 12 de Octubre, Cromsource
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1. Study Identification

Unique Protocol Identification Number
NCT04648280
Brief Title
Safety and Pharmacokinetics Evaluation of Fostemsavir + (OBT) in HIV-1 Infected Children and Adolescents Who Are Failing Their cART and Have Dual- or Triple-class Antiretroviral Resistance
Official Title
A Multicenter, Open-label, Single-arm Trial to Evaluate the Safety, Pharmacokinetics and Antiviral Activity of Fostemsavir in Combination With Optimized Background Therapy (OBT) in HIV-1 Infected Children and Adolescents Who Are Failing Their Current Combination Antiretroviral Therapy (cART) and Have Dual- or Triple-class Antiretroviral (ARV) Resistance
Study Type
Interventional

2. Study Status

Record Verification Date
March 2023
Overall Recruitment Status
Recruiting
Study Start Date
June 30, 2022 (Actual)
Primary Completion Date
June 2024 (Anticipated)
Study Completion Date
June 2027 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
PENTA Foundation
Collaborators
ViiV Healthcare, PHPT Foundation, Hospital Universitario 12 de Octubre, Cromsource

4. Oversight

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

5. Study Description

Brief Summary
In the SHIELD study, the study sponsor seeks to assess safety, PK and antiviral activity for children and adolescents with dual or triple class resistance. It will also assess the acceptability and swallowability of formulation among the pediatric population. The dose selection of FTR for children and adolescents ≥20kg utilized a population pharmacokinetic (POP PK) model-based approach to achieve similar adult TMR exposures following FTR 600mg BID administration with combination therapy that was demonstrated to be safe and effective in the FTR Phase 3 BRIGHTE study in HTE patients.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
HIV Infections With Multi Drug Resistant Virus

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
60 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Fostemsavir
Arm Type
Experimental
Arm Description
Fostemsavir in combination with optimized background therapy (OBT) in HIV-1 infected children and adolescents who are failing their current combination antiretroviral therapy (cART) and have dual- or triple-class ARV resistance
Intervention Type
Drug
Intervention Name(s)
Fostemsavir
Intervention Description
fostemsavir in combination with optimized background therapy (OBT) in HIV-1 infected children and adolescents who are failing their current combination antiretroviral therapy (cART) and have dual- or triple-class ARV resistance
Primary Outcome Measure Information:
Title
Occurrence of the following events through Week 24
Time Frame
24 weeks
Title
AUC(0-tau)
Time Frame
at week 1, 4, 12, 24, 48
Title
Cmax
Time Frame
at week 1, 4, 12, 24, 48
Title
Ctau of temsavir across weight bands
Time Frame
at week 1, 4, 12, 24, 48
Secondary Outcome Measure Information:
Title
Proportion of patients with HIV-1 RNA <50 copies/mL
Description
To evaluate the antiviral activity of fostemsavir + OBT
Time Frame
at 24 weeks and 48 weeks
Title
Change in log10 HIV-1 RNA from baseline
Time Frame
at 24 weeks and 48 weeks
Title
Occurrence of: AEs, treatment-related AEs, AEs of Grade 3 or higher, serious AEs, and AEs leading to premature study treatment discontinuation.
Time Frame
at Week 48 and at the end of Study
Title
Occurrence of WHO 3 or 4 defining events, or death
Time Frame
up to 156 weeks
Title
efficacy of fostemsavir plus OBT
Description
changes from baseline in CD4+ T cell counts and the percentage of CD4 + T-cells
Time Frame
up to 156 weeks
Title
Emergence of genotypic or phenotypic resistance to Temsavir and components of OBT
Time Frame
up to 156 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
6 Years
Maximum Age & Unit of Time
17 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male and female HIV-1 infected paediatric participants from 6 years old and weighing at least 20 kg to less than 18 years of age. Antiretroviral-experienced with documented historical or baseline resistance to one or more agents in at least two classes. All resistance has to be properly documented. Failing current antiretroviral regimen with a confirmed plasma HIV-1 RNA ≥ 1000 c/mL (first value from Investigator within 6 months of screening visit, with the second value obtained from Screening labs, without a decline greater than 1 log10, and no value <1000 in between). Documented resistance to at least one component of the current failing regimen per screening resistance testing. Must have at least 1 fully active and available agent in 2 or more ARV classes, based on current and/or documented historical resistance testing, taking into account tolerability, and other safety concerns. At least two fully active agents must be a part of the initial OBT to be paired with FTR. Girls who have reached menarche must have a negative pregnancy test at screening, not be breastfeeding, and be willing to adhere to effective methods of contraception if sexually active. All participants (male or female) have to agree with recommendations for effective contraception. Exclusion Criteria: Medical History and Concurrent Diseases: Unable to comply with dosing requirements (to swallow solid pharmaceutical form of the investigational medicinal product) Unable to comply with study visits Presence of a malabsorption syndrome or other gastrointestinal dysfunction which might interfere with drug absorption or render the participant unable to take oral medication. Any clinical condition (including but not limited to recreational drug use) or prior therapy that, in the opinion of the Investigator, would make the participant unsuitable for the study Pregnancy and breastfeeding Physical and Laboratory Test Findings: Chronic untreated Hepatitis B virus (HBV) (however, participants with chronic treated HBV or spontaneously remitted HBV are eligible) HIV-2 infection Alanine aminotransferase (ALT) ≥5 times the upper limit of normal (ULN), OR ALT ≥3xULN and bilirubin ≥1.5xULN (with>35% direct bilirubin) History of unstable liver disease, decompensated cirrhosis, or known biliary disorder History of congestive heart failure, or congenital/acquired prolonged QT syndrome/other cardiac diseases predisposing to prolonged QTc Hemoglobin < 8.0 g/dL Platelets < 50,000 cells/mm3 Confirmed QTcF value > 450 msec, regardless of sex, at Screening or Day 1 Current (defined as taking the medication within 14 days of Day 1) or anticipated treatment with medication considered prohibited or restricted as per Appendix II. Certain medication will be carefully evaluated as acceptable, see Appendix II. Participation in an experimental drug and/or HIV-1 vaccine trial(s) within the previous 30 days Child in governmental care, e.g. child is a ward of the state. Note: This criterion does not apply if the child is officially adopted by a family/guardian.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Pablo Rojo
Phone
7169822
Ext
0039049
Email
pablorojoconejo@netscape.net
First Name & Middle Initial & Last Name or Official Title & Degree
Alessandra Nardone
Phone
7169822
Ext
0039049
Email
alessandra.nardone@pentafoundation.org
Facility Information:
Facility Name
The George Washington University, Children's National Health System
City
Washington
State/Province
District of Columbia
ZIP/Postal Code
20010
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Natella Rakhmanina
Email
NRakhman@childrensnational.org
Facility Name
Children's Healthcare of Atlanta
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30322
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Andres Camacho-Gonzalez
Email
acamac2@emory.edu
Facility Name
Hospital General Mexico
City
Mexico City
Country
Mexico
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Noris Pavia Ruz
Email
norpavruz@yahoo.com.mx
Facility Name
FAM-CRU
City
Cape Town
Country
South Africa
Individual Site Status
Active, not recruiting
Facility Name
King Edward VIII Hospital
City
Durban
Country
South Africa
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Moherndran Archary
Email
archary@ukzn.ac.za
Facility Name
Rahima Moosa Mother and Child Hospital
City
Johannesburg
ZIP/Postal Code
2112
Country
South Africa
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Renate Strehlau
Email
Renate.Strehlau@wits.ac.za
Facility Name
Wits Reproductive Health and HIV Institutel
City
Johannesburg
Country
South Africa
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Feezah Patel
Email
faeezah.patel@wits.ac.za
Facility Name
PHRU
City
Soweto
Country
South Africa
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Avy Violari
Email
violari@mweb.co.za
Facility Name
Hospital 12 de Octubre
City
Madrid
Country
Spain
Individual Site Status
Active, not recruiting

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Safety and Pharmacokinetics Evaluation of Fostemsavir + (OBT) in HIV-1 Infected Children and Adolescents Who Are Failing Their cART and Have Dual- or Triple-class Antiretroviral Resistance

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