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Oral Islatravir (MK-8591) Once-Monthly as Preexposure Prophylaxis (PrEP) in Men and Transgender Women Who Are at High Risk for HIV-1 Infection (MK-8591-024) (Impower-024)

Primary Purpose

HIV Preexposure Prophylaxis

Status
Completed
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
ISL
FTC/TDF
FTC/TAF
Placebo to ISL
Placebo to FTC/TDF
Placebo to FTC/TAF
Sponsored by
Merck Sharp & Dohme LLC
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for HIV Preexposure Prophylaxis focused on measuring Preexposure prophylaxis (PrEP), Prevention

Eligibility Criteria

16 Years - undefined (Child, Adult, Older Adult)MaleAccepts Healthy Volunteers

Inclusion Criteria:

  • Has confirmed Human Immunodeficiency Virus (HIV) uninfected based on negative HIV-1/HIV-2 test result before randomization
  • Is sexually active with male or transgender women (TGW) partners defined as having anal sexual intercourse with a man or TGW at least once in the past month
  • Is at high risk for sexually acquiring HIV-1 infection based on self-report of at least 1 of the following: a) Condomless receptive anal intercourse in the 6 months prior to screening occurring outside a mutually monogamous HIV seronegative concordant relationship b) More than 5 partners (anal intercourse) in the 6 months prior to screening c) Any unprescribed stimulant drug use in the 6 months prior to screening d) Rectal or urethral gonorrhea or chlamydia or incident syphilis in the 6 months prior to screening
  • Participants 16 or 17 years of age must weigh ≥35 kg. Enrollment for 16- to 17-year-old participants will begin only after completion of the Sentinel Cohort IA and review of IA results by the external data monitoring committee (eDMC)
  • Has no plans to relocate or travel away from the site for ≥4 consecutive weeks during study participation

Exclusion Criteria:

  • Has hypersensitivity or other contraindication to any component of the study interventions as determined by the investigator
  • Has chronic HBV infection or past HBV infection which could indicate risk for Hepatitis B reactivation
  • Has known current or chronic history of liver disease or known hepatic or biliary abnormalities, unless the participant has stable liver function tests and no evidence of hepatic synthetic dysfunction
  • Has a history of malignancy within 5 years of screening except for adequately treated basal cell or squamous cell skin cancer or in situ anal cancers
  • Has a history or current evidence of any condition, therapy, laboratory abnormality or other circumstance 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 enroll
  • Has taken cabotegravir, lenacapavir, or any other long-acting HIV prevention product at any time
  • Is currently receiving or is anticipated to require any prohibited therapies outlined in the study from 30 days prior to Day 1 through the duration of the study
  • Is currently participating in or has participated in an interventional or prevention clinical study with an investigational compound or device, within 30 days prior to Day 1 through the duration of the study
  • Has exclusionary laboratory values within 45 days prior to Day 1

Sites / Locations

  • University of Alabama at Birmingham-UAB 1917 Research Clinic ( Site 0007)
  • UCLA Center for Clinical AIDS Research and Education ( Site 0011)
  • Global Research Institute ( Site 0031)
  • Bridge HIV - San Francisco Department of Public Health ( Site 0003)
  • The GW Medical Faculty Associates-Medicine ( Site 0033)
  • Midway Immunology and Research Center ( Site 0014)
  • University of Miami Miller School of Medicine-Infectious Disease ( Site 0029)
  • Orlando Immunology Center ( Site 0010)
  • Ponce De Leon Center Grady Health ( Site 0032)
  • Howard Brown Health Center ( Site 0004)
  • The University of Mississippi Medical Center ( Site 0012)
  • Rutgers New Jersey Medical School-Clinical Research Center ( Site 0017)
  • The University of North Carolina at Chapel Hill ( Site 0019)
  • Central Texas Clinical Research ( Site 0002)
  • The Crofoot Research Center ( Site 0025)
  • Centro de Referência e Treinamento DST/AIDS ( Site 0351)
  • Hôpital Saint-Louis-Infectious Diseases and tropical diseases ( Site 0151)
  • Center Hospital of the National Center for Global Health and Medicine ( Site 0101)
  • Via Libre ( Site 0404)
  • Perinatal HIV Research Unit (PHRU)-HIV Prevention CRS ( Site 0203)
  • Wits Reproductive Health and HIV Institute (WRHI)-Research Center ( Site 0201)
  • Desmond Tutu HIV Foundation ( Site 0202)
  • Chulalongkorn University-Pediatrics ( Site 0051)
  • HIV Netherlands Australia Thailand Research Collaboration ( Site 0056)
  • Research Institute for Health Sciences-Research Institute for Health Sciences Building 1 ( Site 0052

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Islatravir (ISL) Once Monthly (QM) Group

FTC/TDF or FTC/TAF QD Group

Arm Description

Participants receive 60 mg tablet of ISL QM, orally plus Placebo to Emtricitabine/Tenofovir Disoproxil Fumarate (FTC/TDF) tablet once daily (QD) or Placebo to Emtricitabine/Tenofovir Alafenamide (FTC/TAF) tablet QD, orally for up to 24 months of treatment duration.

Participants receive 200/245 mg or 200/300 mg of FTC/TDF combination tablet, QD, orally or 200/25 mg of FTC/TAF combination tablet, QD, orally at investigator's discretion plus Placebo to ISL tablet QM, orally for up to 24 months of treatment duration.

Outcomes

Primary Outcome Measures

Percentage of Participants Who Experienced an 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. The percentage of participants who experienced an AE will be reported for each treatment arm.
Percentage of Participants Who Discontinued 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. The percentage of participants who experienced an AE will be reported for each treatment arm.

Secondary Outcome Measures

Incidence Rate Per Year of Confirmed HIV-1 infection Among Participants
Incidence rate per year of confirmed HIV-1 infections is the number of participants with confirmed HIV-1 infections divided by the amount of person-years of follow-up time to HIV-1 infection status. The secondary incidence analysis to compare the incidence rate per year of confirmed HIV-1 Infections between the ISL QM arm and the FTC/TDF or FTC/TAF QD arm participants. HIV serology tests and PCR tests will be done at pre-specified timepoints to confirm HIV-1 infection.

Full Information

First Posted
December 2, 2020
Last Updated
August 16, 2023
Sponsor
Merck Sharp & Dohme LLC
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1. Study Identification

Unique Protocol Identification Number
NCT04652700
Brief Title
Oral Islatravir (MK-8591) Once-Monthly as Preexposure Prophylaxis (PrEP) in Men and Transgender Women Who Are at High Risk for HIV-1 Infection (MK-8591-024)
Acronym
Impower-024
Official Title
A Phase 3, Randomized, Active-Controlled, Double-Blind Clinical Study to Evaluate the Efficacy and Safety of Oral Islatravir Once-Monthly as Preexposure Prophylaxis in Cisgender Men and Transgender Women Who Have Sex With Men, and Are at High Risk for HIV-1 Infection
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Completed
Study Start Date
March 15, 2021 (Actual)
Primary Completion Date
August 4, 2023 (Actual)
Study Completion Date
August 4, 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
The main purpose of the study is to evaluate the safety and tolerability of oral Islatravir (ISL) once monthly (QM) as Preexposure Prophylaxis (PrEP) in cisgender men who have sex with men (MSM) and transgender women (TGW) who have sex with men and who are at high risk of HIV-1 infection with 48 or 96 weeks of treatment and a minimum follow-up of 42 days.
Detailed Description
Based on laboratory findings of decreased lymphocyte and CD4+ T-cell counts across the islatravir program, dosing of blinded study intervention was halted on 13-Dec-2021. Blinded assessments conducted prior to then are designated as Study Part 1. During Study Part 2, participants from Part 1 were switched to PrEP therapy with emtricitabine/tenofovir disoproxil (FTC/TDF) or emtricitabine/tenofovir alafenamide (FTC/TAF) while continuing in the study. In Part 3, participants, investigators, and all Sponsor personnel are unblinded to participant's original randomized intervention group, and participants may continue to receive unblinded FTC/TDF or FTC/TAF. Screening and randomization of new participants have stopped, with no new participants being enrolled in Part 2 or Part 3.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
HIV Preexposure Prophylaxis
Keywords
Preexposure prophylaxis (PrEP), Prevention

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Masking Description
In Study Part 1, double-blind with in-house blinding is used. In Study Part 2, sponsor personnel not directly involved with blinded safety monitoring will be unblinded to participants' randomized study intervention in Part 1 (personnel involved with Part 2 will remain blinded). In Study Part 3, al participants, investigators, and Sponsor personnel are unblinded as to the participant's original randomized intervention group.
Allocation
Randomized
Enrollment
494 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Islatravir (ISL) Once Monthly (QM) Group
Arm Type
Experimental
Arm Description
Participants receive 60 mg tablet of ISL QM, orally plus Placebo to Emtricitabine/Tenofovir Disoproxil Fumarate (FTC/TDF) tablet once daily (QD) or Placebo to Emtricitabine/Tenofovir Alafenamide (FTC/TAF) tablet QD, orally for up to 24 months of treatment duration.
Arm Title
FTC/TDF or FTC/TAF QD Group
Arm Type
Active Comparator
Arm Description
Participants receive 200/245 mg or 200/300 mg of FTC/TDF combination tablet, QD, orally or 200/25 mg of FTC/TAF combination tablet, QD, orally at investigator's discretion plus Placebo to ISL tablet QM, orally for up to 24 months of treatment duration.
Intervention Type
Drug
Intervention Name(s)
ISL
Other Intervention Name(s)
MK-8591
Intervention Description
ISL 60 mg tablet, QM, orally for up to 24 months
Intervention Type
Drug
Intervention Name(s)
FTC/TDF
Other Intervention Name(s)
Truvada, Emtricitabine/Tenofovir Disoproxil Fumarate
Intervention Description
Participants receive 200/245 mg of FTC/TDF combination tablet, QD, orally for up to 24 months
Intervention Type
Drug
Intervention Name(s)
FTC/TAF
Other Intervention Name(s)
Descovy, Emtricitabine/Tenofovir Alafenamide
Intervention Description
Participants receive 200/25 mg of FTC/TAF combination tablet, QD, orally for up to 24 months
Intervention Type
Drug
Intervention Name(s)
Placebo to ISL
Intervention Description
Placebo ISL 0 mg tablets QM, orally for up to 24 months.
Intervention Type
Drug
Intervention Name(s)
Placebo to FTC/TDF
Intervention Description
Placebo FTC/TDF 0 mg tablets QD, orally for up to 24 months
Intervention Type
Drug
Intervention Name(s)
Placebo to FTC/TAF
Intervention Description
Placebo FTC/TAF 0 mg tablets QD, orally for up to 24 months
Primary Outcome Measure Information:
Title
Percentage of Participants Who Experienced an 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. The percentage of participants who experienced an AE will be reported for each treatment arm.
Time Frame
Up to approximately 26 months
Title
Percentage of Participants Who Discontinued 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. The percentage of participants who experienced an AE will be reported for each treatment arm.
Time Frame
Up to approximately 24 months
Secondary Outcome Measure Information:
Title
Incidence Rate Per Year of Confirmed HIV-1 infection Among Participants
Description
Incidence rate per year of confirmed HIV-1 infections is the number of participants with confirmed HIV-1 infections divided by the amount of person-years of follow-up time to HIV-1 infection status. The secondary incidence analysis to compare the incidence rate per year of confirmed HIV-1 Infections between the ISL QM arm and the FTC/TDF or FTC/TAF QD arm participants. HIV serology tests and PCR tests will be done at pre-specified timepoints to confirm HIV-1 infection.
Time Frame
Up to approximately 24 months

10. Eligibility

Sex
Male
Gender Based
Yes
Gender Eligibility Description
Male participants and transgender women (TGW) who are at high risk for HIV-1 infection
Minimum Age & Unit of Time
16 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Has confirmed Human Immunodeficiency Virus (HIV) uninfected based on negative HIV-1/HIV-2 test result before randomization Is sexually active with male or transgender women (TGW) partners defined as having anal sexual intercourse with a man or TGW at least once in the past month Is at high risk for sexually acquiring HIV-1 infection based on self-report of at least 1 of the following: a) Condomless receptive anal intercourse in the 6 months prior to screening occurring outside a mutually monogamous HIV seronegative concordant relationship b) More than 5 partners (anal intercourse) in the 6 months prior to screening c) Any unprescribed stimulant drug use in the 6 months prior to screening d) Rectal or urethral gonorrhea or chlamydia or incident syphilis in the 6 months prior to screening Participants 16 or 17 years of age must weigh ≥35 kg. Enrollment for 16- to 17-year-old participants will begin only after completion of the Sentinel Cohort IA and review of IA results by the external data monitoring committee (eDMC) Has no plans to relocate or travel away from the site for ≥4 consecutive weeks during study participation Exclusion Criteria: Has hypersensitivity or other contraindication to any component of the study interventions as determined by the investigator Has chronic HBV infection or past HBV infection which could indicate risk for Hepatitis B reactivation Has known current or chronic history of liver disease or known hepatic or biliary abnormalities, unless the participant has stable liver function tests and no evidence of hepatic synthetic dysfunction Has a history of malignancy within 5 years of screening except for adequately treated basal cell or squamous cell skin cancer or in situ anal cancers Has a history or current evidence of any condition, therapy, laboratory abnormality or other circumstance 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 enroll Has taken cabotegravir, lenacapavir, or any other long-acting HIV prevention product at any time Is currently receiving or is anticipated to require any prohibited therapies outlined in the study from 30 days prior to Day 1 through the duration of the study Is currently participating in or has participated in an interventional or prevention clinical study with an investigational compound or device, within 30 days prior to Day 1 through the duration of the study Has exclusionary laboratory values within 45 days prior to Day 1
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
University of Alabama at Birmingham-UAB 1917 Research Clinic ( Site 0007)
City
Birmingham
State/Province
Alabama
ZIP/Postal Code
35222
Country
United States
Facility Name
UCLA Center for Clinical AIDS Research and Education ( Site 0011)
City
Los Angeles
State/Province
California
ZIP/Postal Code
90035
Country
United States
Facility Name
Global Research Institute ( Site 0031)
City
Los Angeles
State/Province
California
ZIP/Postal Code
90036
Country
United States
Facility Name
Bridge HIV - San Francisco Department of Public Health ( Site 0003)
City
San Francisco
State/Province
California
ZIP/Postal Code
94102
Country
United States
Facility Name
The GW Medical Faculty Associates-Medicine ( Site 0033)
City
Washington
State/Province
District of Columbia
ZIP/Postal Code
20037
Country
United States
Facility Name
Midway Immunology and Research Center ( Site 0014)
City
Fort Pierce
State/Province
Florida
ZIP/Postal Code
34982
Country
United States
Facility Name
University of Miami Miller School of Medicine-Infectious Disease ( Site 0029)
City
Miami
State/Province
Florida
ZIP/Postal Code
33136
Country
United States
Facility Name
Orlando Immunology Center ( Site 0010)
City
Orlando
State/Province
Florida
ZIP/Postal Code
32803
Country
United States
Facility Name
Ponce De Leon Center Grady Health ( Site 0032)
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30308
Country
United States
Facility Name
Howard Brown Health Center ( Site 0004)
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60613
Country
United States
Facility Name
The University of Mississippi Medical Center ( Site 0012)
City
Jackson
State/Province
Mississippi
ZIP/Postal Code
39216
Country
United States
Facility Name
Rutgers New Jersey Medical School-Clinical Research Center ( Site 0017)
City
Newark
State/Province
New Jersey
ZIP/Postal Code
07103
Country
United States
Facility Name
The University of North Carolina at Chapel Hill ( Site 0019)
City
Chapel Hill
State/Province
North Carolina
ZIP/Postal Code
27599
Country
United States
Facility Name
Central Texas Clinical Research ( Site 0002)
City
Austin
State/Province
Texas
ZIP/Postal Code
78705
Country
United States
Facility Name
The Crofoot Research Center ( Site 0025)
City
Houston
State/Province
Texas
ZIP/Postal Code
77098
Country
United States
Facility Name
Centro de Referência e Treinamento DST/AIDS ( Site 0351)
City
Sao Paulo
ZIP/Postal Code
04121-000
Country
Brazil
Facility Name
Hôpital Saint-Louis-Infectious Diseases and tropical diseases ( Site 0151)
City
Paris
State/Province
Ile-de-France
ZIP/Postal Code
75010
Country
France
Facility Name
Center Hospital of the National Center for Global Health and Medicine ( Site 0101)
City
Shinjyuku-ku
State/Province
Tokyo
ZIP/Postal Code
162-8655
Country
Japan
Facility Name
Via Libre ( Site 0404)
City
Lima
ZIP/Postal Code
15001
Country
Peru
Facility Name
Perinatal HIV Research Unit (PHRU)-HIV Prevention CRS ( Site 0203)
City
Johannesburg
State/Province
Gauteng
ZIP/Postal Code
1864
Country
South Africa
Facility Name
Wits Reproductive Health and HIV Institute (WRHI)-Research Center ( Site 0201)
City
Johannesburg
State/Province
Gauteng
ZIP/Postal Code
2000
Country
South Africa
Facility Name
Desmond Tutu HIV Foundation ( Site 0202)
City
Cape Town
State/Province
Western Cape
ZIP/Postal Code
7925
Country
South Africa
Facility Name
Chulalongkorn University-Pediatrics ( Site 0051)
City
Bangkok
State/Province
Krung Thep Maha Nakhon
ZIP/Postal Code
10330
Country
Thailand
Facility Name
HIV Netherlands Australia Thailand Research Collaboration ( Site 0056)
City
Bangkok
State/Province
Krung Thep Maha Nakhon
ZIP/Postal Code
10330
Country
Thailand
Facility Name
Research Institute for Health Sciences-Research Institute for Health Sciences Building 1 ( Site 0052
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
Links:
URL
http://www.merckclinicaltrials.com
Description
Merck Clinical Trials Information

Learn more about this trial

Oral Islatravir (MK-8591) Once-Monthly as Preexposure Prophylaxis (PrEP) in Men and Transgender Women Who Are at High Risk for HIV-1 Infection (MK-8591-024)

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