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A Multicenter Study to Assess the Tolerability of Once Daily Lopinavir/Ritonavir (LPV/r) Liquid Versus Capsules

Primary Purpose

HIV Infection

Status
Completed
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
Different formulations of once-daily lopinavir/ritonavir
Sponsored by
University of California, San Diego
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for HIV Infection focused on measuring Lopinavir, antiretroviral therapy, cross-over, tolerability

Eligibility Criteria

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

Inclusion Criteria: Ability and willingness of subject or legal guardian/representative to give written informed consent. HIV-1 infected. At least 18 years of age Have the last two HIV-1 RNA measurements performed prior to screening be <50 or 75 copies/mL within the last 180 days, as well as at the time of screening. No evidence of primary PI mutations (defined by IAS-USA) documented on previous resistance testing, if ever performed and available, or suggested to be present by previous treatment history. Laboratory values: Absolute neutrophil count (ANC) >500/mm3. -Hemoglobin >7.0 g/dL. platelet count >50,000/mm3. AST (SGOT), ALT (SGPT), and alkaline phosphatase <5 X ULN. Total bilirubin <2.5 x ULN, unless on IDV or ATV in which case must be <1.5 x ULN of direct bilirubin. Calculated creatinine clearance >50 mL/min as estimated by the Cockcroft-Gault equation For women of reproductive potential, negative serum or urine pregnancy test within 7 days prior to initiating study medications. If participating in sexual activity that could lead to pregnancy, female study subjects must use two forms of contraception, one of which must be a barrier method. All subjects must continue to use contraception for 6 weeks after stopping the study medications. Willingness to take an alcohol containing product. Karnofsky performance score >70. Exclusion Criteria: Pregnancy or breast-feeding Greater than Grade 1 diarrhea or nausea (as defined by protocol) Use of a NNRTI within 12 weeks of screening Use of antimotility or antiemetics during the 14 days prior to screening Use of any of the prohibited medications (defined by protocol) within 30 days of study entry. Need to continue the use of prohibited or select precautionary medications (defined by protocol) Known hypersensitivity to lopinavir/ritonavir Active drug or alcohol use or dependence which, in the Investigator's opinion, may interfere with adherence to study requirements or endanger subject's health while on the study Serious illness requiring systemic treatment and/or hospitalization until subject either completes therapy or is clinically stable on therapy, in the opinion of the investigator, for at least 30 days prior to study entry. Acute therapy for serious infection or other serious medical illnesses (in the judgment of the site investigator) requiring systemic treatment and/or hospitalization within 14 days prior to study entry. Use of immunomodulators (e.g., interleukins, interferons, cyclosporine), HIV-1 vaccine, systemic cytotoxic chemotherapy, or investigational therapy within 30 days prior to study entry

Sites / Locations

  • UCI
  • USC
  • UCSD
  • Santa Clara Valley Medical Center
  • Harbor-UCLA Medical Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

LPV/r (800/200 mg) 10 ml liquid

LPV/r (800/200 mg) 6 gel capsules

Arm Description

Once daily Lopinovir/ritonavir (800/200 mg) taken as a 10 ml liquid

Once daily Lopinavir/ritonavir (800/200 mg) as 6 gel capsules

Outcomes

Primary Outcome Measures

Measuring whether the subject has severity of diarrhea grade 2 or higher or exhibits treatment-limiting toxicity when treated with once daily Lopinavir/ritonavir [LPV/r] (800/200 mg) as 10 ml liquid vs. 6 soft gel capsules.
To assess the comparative tolerability of once daily Lopinavir/ritonavir [LPV/r] (800/200 mg) as 10 ml liquid vs. 6 soft gel capsules by measuring incidence rates as assessed by the CTCAE v4.0 in each arm of: a) grade 2 or higher diarrhea plus b) dose limiting toxicity of any kind.

Secondary Outcome Measures

Incidence Measures of Treatment-limiting toxicity
Separately evaluating at the end of week 4 or at the time therapy is discontinued for treatment-limiting toxicity of the two 4 week phases of the cross-over trial (Steps 1 and 2).
Incidence Measures of Drug-related diarrhea
Separately evaluating at the end of week 4 or at the time therapy is discontinued for drug-related diarrhea of the two 4 week phases of the cross-over trial (Steps 1 and 2).
Incidence Measures of the Use of antiemetic and/or antimotility therapy
Separately evaluating at the end of week 4 or at the time therapy is discontinued for antiemetic and/or antimotility therapy of the two 4 week phases of the cross-over trial (Steps 1 and 2).
Incidence Measures of Adverse events other than nausea and diarrhea
Separately evaluating at the end of week 4 or at the time therapy is discontinued for adverse events other than nausea and diarrhea of the two 4 week phases of the cross-over trial (Steps 1 and 2).
Incidence Measures of Laboratory abnormalities, e.g. lipids, liver enzymes
Separately evaluating at the end of week 4 or at the time therapy is discontinued for laboratory abnormalities of the two 4 week phases of the cross-over trial (Steps 1 and 2).
Incidence Measures of HIV RNA suppression to <50 copies/ml
Separately evaluating at the end of week 4 or at the time therapy is discontinued for HIV RNA suppression to <50 copies/ml of the two 4 week phases of the cross-over trial (Steps 1 and 2).
Preference for Lopinavir/ritonavir liquid, capsules or tablets, and the degree of like or dislike of each
The stated preference for LPV/r liquid, capsules or tablets, and the degree of like or dislike of each in those who choose an option other than once daily LPV/r tablets at start of Step 4
Evaluating the proportion of screened individuals who choose not to be randomized after the liquid Lopinavir/ritonavir taste test
Evaluating the proportion of screened individuals who choose not to be randomized after the liquid LPV/r taste test at the time of enrollment into the study
Evaluating the severity of diarrhea
Measuring sum of days with diarrhea weighted for highest level of severity (sum of event severity numbers = 1-5) on that day via the Division of AIDS Table for Grading Adult Adverse Experiences that can be found on the ROC Web site: http://rcc.tech-res-intl.com/
Evaluating the severity of nausea
Measuring days of nausea weighted for the highest level of severity (sum of event severity numbers = 1-5) on that day via the Division of AIDS Table for Grading Adult Adverse Experiences that can be found on the ROC Web site: http://rcc.tech-res-intl.com/
Evaluating proportion with plasma HIV RNA <50 copies/mL at the end of Step 4
Evaluating the proportion of participants with plasma HIV RNA <50 copies/mL at the end of Step 4

Full Information

First Posted
January 23, 2006
Last Updated
June 25, 2020
Sponsor
University of California, San Diego
Collaborators
Abbott
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1. Study Identification

Unique Protocol Identification Number
NCT00281606
Brief Title
A Multicenter Study to Assess the Tolerability of Once Daily Lopinavir/Ritonavir (LPV/r) Liquid Versus Capsules
Official Title
A Phase IV, Randomized, Open-label Study of the Tolerability of Once Daily Lopinavir/Ritonavir (LPV/r) Liquid Versus Capsules
Study Type
Interventional

2. Study Status

Record Verification Date
June 2020
Overall Recruitment Status
Completed
Study Start Date
February 14, 2006 (Actual)
Primary Completion Date
October 16, 2007 (Actual)
Study Completion Date
June 13, 2012 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of California, San Diego
Collaborators
Abbott

4. Oversight

5. Study Description

Brief Summary
Guidelines have continued to list lopinavir/ritonavir as a preferred protease inhibitor-containing regimen for HIV-infected individuals. There has recently been increasing interest in once daily therapy. While lopinavir/ritonavir has recently been approved as a once daily therapy it was associated with considerable diarrhea in those treated with soft gel capsules. It is the hope that alternative formulations of lopinavir/ritonavir may provide similar pharmacokinetics with improved tolerability. This includes the possibility of using liquid or newly released tablets. This study will treat people tolerating their current regimen with up to four weeks of each formulation with several assessments of pharmacokinetics and tolerability for each.
Detailed Description
This study is designed to assess the tolerability of different forms (liquid, capsules or tablets) of lopinavir/ritonavir given once-daily as part of combination therapy for HIV infection. Study subjects will be those tolerating a stable regimen of HIV medications with undetectable levels of HIV in their blood. They will be assigned by chance to receive once daily liquid or soft gel capsules of lopinavir/ritonavir for up to four weeks. At that time they will receive the alternative formulation for up to four weeks. They will then be given once daily lopinavir/ritonavir in the recently released tablet formulation. After up to four weeks of each of these formulations several assessments will be made of the overall tolerability of the drug. After four weeks of tablets they will be allowed to take whatever regimen they want and will be followed for an additional 36 weeks for a total duration of study of up to 48 weeks. The pharmacokinetics of each formulation of lopinavir/ritonavir given once daily will also be assessed in a subset of study subjects.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
HIV Infection
Keywords
Lopinavir, antiretroviral therapy, cross-over, tolerability

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Crossover Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
65 (Actual)

8. Arms, Groups, and Interventions

Arm Title
LPV/r (800/200 mg) 10 ml liquid
Arm Type
Active Comparator
Arm Description
Once daily Lopinovir/ritonavir (800/200 mg) taken as a 10 ml liquid
Arm Title
LPV/r (800/200 mg) 6 gel capsules
Arm Type
Active Comparator
Arm Description
Once daily Lopinavir/ritonavir (800/200 mg) as 6 gel capsules
Intervention Type
Drug
Intervention Name(s)
Different formulations of once-daily lopinavir/ritonavir
Other Intervention Name(s)
Lopinavir/Ritonavir (LPV/r)
Intervention Description
CCTG585 is a randomized, open-label, two arm cross-over study to compare the tolerability of once daily LPV/r liquid versus capsules
Primary Outcome Measure Information:
Title
Measuring whether the subject has severity of diarrhea grade 2 or higher or exhibits treatment-limiting toxicity when treated with once daily Lopinavir/ritonavir [LPV/r] (800/200 mg) as 10 ml liquid vs. 6 soft gel capsules.
Description
To assess the comparative tolerability of once daily Lopinavir/ritonavir [LPV/r] (800/200 mg) as 10 ml liquid vs. 6 soft gel capsules by measuring incidence rates as assessed by the CTCAE v4.0 in each arm of: a) grade 2 or higher diarrhea plus b) dose limiting toxicity of any kind.
Time Frame
Baseline to week 48
Secondary Outcome Measure Information:
Title
Incidence Measures of Treatment-limiting toxicity
Description
Separately evaluating at the end of week 4 or at the time therapy is discontinued for treatment-limiting toxicity of the two 4 week phases of the cross-over trial (Steps 1 and 2).
Time Frame
Baseline to week 48
Title
Incidence Measures of Drug-related diarrhea
Description
Separately evaluating at the end of week 4 or at the time therapy is discontinued for drug-related diarrhea of the two 4 week phases of the cross-over trial (Steps 1 and 2).
Time Frame
Baseline to week 48
Title
Incidence Measures of the Use of antiemetic and/or antimotility therapy
Description
Separately evaluating at the end of week 4 or at the time therapy is discontinued for antiemetic and/or antimotility therapy of the two 4 week phases of the cross-over trial (Steps 1 and 2).
Time Frame
Baseline to week 48
Title
Incidence Measures of Adverse events other than nausea and diarrhea
Description
Separately evaluating at the end of week 4 or at the time therapy is discontinued for adverse events other than nausea and diarrhea of the two 4 week phases of the cross-over trial (Steps 1 and 2).
Time Frame
Baseline to week 48
Title
Incidence Measures of Laboratory abnormalities, e.g. lipids, liver enzymes
Description
Separately evaluating at the end of week 4 or at the time therapy is discontinued for laboratory abnormalities of the two 4 week phases of the cross-over trial (Steps 1 and 2).
Time Frame
Baseline to week 48
Title
Incidence Measures of HIV RNA suppression to <50 copies/ml
Description
Separately evaluating at the end of week 4 or at the time therapy is discontinued for HIV RNA suppression to <50 copies/ml of the two 4 week phases of the cross-over trial (Steps 1 and 2).
Time Frame
Baseline to week 48
Title
Preference for Lopinavir/ritonavir liquid, capsules or tablets, and the degree of like or dislike of each
Description
The stated preference for LPV/r liquid, capsules or tablets, and the degree of like or dislike of each in those who choose an option other than once daily LPV/r tablets at start of Step 4
Time Frame
Week 8 and week 48
Title
Evaluating the proportion of screened individuals who choose not to be randomized after the liquid Lopinavir/ritonavir taste test
Description
Evaluating the proportion of screened individuals who choose not to be randomized after the liquid LPV/r taste test at the time of enrollment into the study
Time Frame
Baseline
Title
Evaluating the severity of diarrhea
Description
Measuring sum of days with diarrhea weighted for highest level of severity (sum of event severity numbers = 1-5) on that day via the Division of AIDS Table for Grading Adult Adverse Experiences that can be found on the ROC Web site: http://rcc.tech-res-intl.com/
Time Frame
Week 4, week 8 and week 48
Title
Evaluating the severity of nausea
Description
Measuring days of nausea weighted for the highest level of severity (sum of event severity numbers = 1-5) on that day via the Division of AIDS Table for Grading Adult Adverse Experiences that can be found on the ROC Web site: http://rcc.tech-res-intl.com/
Time Frame
Week 4, week 8 and week 48
Title
Evaluating proportion with plasma HIV RNA <50 copies/mL at the end of Step 4
Description
Evaluating the proportion of participants with plasma HIV RNA <50 copies/mL at the end of Step 4
Time Frame
Week 4, week 8 and week 48
Other Pre-specified Outcome Measures:
Title
Direct inspection of Pre-dose concentrations (Cpre-dose) for Lopinavir/ritonavir (LPV/r)
Description
Direct inspection of the concentration data to assess Pre-dose concentrations (Cpre-dose) for Lopinavir/ritonavir (LPV/r) liquid, capsules and tablets
Time Frame
Baseline and 12 weeks
Title
Direct inspection of trough concentrations (Ctrough) for Lopinavir/ritonavir (LPV/r)
Description
The magnitude of difference within patients of the two formulations will be assessed with the Wilcoxon signed-rank test. The trough concentrations of the Group 2 subjects may also be compared using the Wilcoxon signed-rank test to detect a difference between the formulations.
Time Frame
Baseline and 12 weeks
Title
Direct inspection of 24-hour post-dose concentrations (C24) for Lopinavir/ritonavir (LPV/r)
Description
Model dependent and independent traditional pharmacokinetic approaches will be used to estimate pharmacokinetic parameters, such as the area under the concentration versus time curve from time 0 to 24 hours (AUC0-24).
Time Frame
Baseline and 12 weeks
Title
Direct inspection of maximum plasma concentrations (Cmax) for Lopinavir/ritonavir (LPV/r)
Description
Determine TDF plasma and urine concentrations in Group 1 patients taking TDF concurrently with LPV/r (Group 3).
Time Frame
Baseline and 12 weeks
Title
Direct inspection of the corresponding time to Cmax (Tmax) for Lopinavir/ritonavir (LPV/r)
Description
Model dependent and independent traditional pharmacokinetic approaches will be used to estimate pharmacokinetic parameters, such as the area under the concentration versus time curve from time 0 to 24 hours (AUC0-24), the terminal half-life (t1/2), the apparent clearance (CL/F), and the apparent volume of distribution (Vz/F).
Time Frame
Baseline and 12 weeks
Title
Estimation of concentration versus time curve from time 0 to 24 hours (AUC0-24) for Lopinavir/ritonavir (LPV/r)
Description
Model dependent and independent traditional pharmacokinetic approaches will be used to estimate concentration versus time curve from time 0 to 24 hours (AUC0-24). The AUC0-24 and Cmax ratios of liquid to capsule LPV/r within subjects will be used to assess bioequivalence.
Time Frame
Baseline and 12 weeks
Title
Estimation of terminal half-life (t1/2) for Lopinavir/ritonavir (LPV/r)
Description
Model dependent and independent traditional pharmacokinetic approaches will be used to estimate terminal half-life (t1/2)
Time Frame
Baseline and 12 weeks
Title
Estimation of apparent clearance (CL/F) for Lopinavir/ritonavir (LPV/r)
Description
Model dependent and independent traditional pharmacokinetic approaches will be used to estimate apparent clearance (CL/F)
Time Frame
Baseline and 12 weeks
Title
Estimation of apparent volume of distribution (Vz/F) for Lopinavir/ritonavir (LPV/r)
Description
Model dependent and independent traditional pharmacokinetic approaches will be used to estimate apparent volume of distribution (Vz/F)
Time Frame
Baseline and 12 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Ability and willingness of subject or legal guardian/representative to give written informed consent. HIV-1 infected. At least 18 years of age Have the last two HIV-1 RNA measurements performed prior to screening be <50 or 75 copies/mL within the last 180 days, as well as at the time of screening. No evidence of primary PI mutations (defined by IAS-USA) documented on previous resistance testing, if ever performed and available, or suggested to be present by previous treatment history. Laboratory values: Absolute neutrophil count (ANC) >500/mm3. -Hemoglobin >7.0 g/dL. platelet count >50,000/mm3. AST (SGOT), ALT (SGPT), and alkaline phosphatase <5 X ULN. Total bilirubin <2.5 x ULN, unless on IDV or ATV in which case must be <1.5 x ULN of direct bilirubin. Calculated creatinine clearance >50 mL/min as estimated by the Cockcroft-Gault equation For women of reproductive potential, negative serum or urine pregnancy test within 7 days prior to initiating study medications. If participating in sexual activity that could lead to pregnancy, female study subjects must use two forms of contraception, one of which must be a barrier method. All subjects must continue to use contraception for 6 weeks after stopping the study medications. Willingness to take an alcohol containing product. Karnofsky performance score >70. Exclusion Criteria: Pregnancy or breast-feeding Greater than Grade 1 diarrhea or nausea (as defined by protocol) Use of a NNRTI within 12 weeks of screening Use of antimotility or antiemetics during the 14 days prior to screening Use of any of the prohibited medications (defined by protocol) within 30 days of study entry. Need to continue the use of prohibited or select precautionary medications (defined by protocol) Known hypersensitivity to lopinavir/ritonavir Active drug or alcohol use or dependence which, in the Investigator's opinion, may interfere with adherence to study requirements or endanger subject's health while on the study Serious illness requiring systemic treatment and/or hospitalization until subject either completes therapy or is clinically stable on therapy, in the opinion of the investigator, for at least 30 days prior to study entry. Acute therapy for serious infection or other serious medical illnesses (in the judgment of the site investigator) requiring systemic treatment and/or hospitalization within 14 days prior to study entry. Use of immunomodulators (e.g., interleukins, interferons, cyclosporine), HIV-1 vaccine, systemic cytotoxic chemotherapy, or investigational therapy within 30 days prior to study entry
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Eric Daar, MD
Organizational Affiliation
University of California, Los Angeles
Official's Role
Principal Investigator
Facility Information:
Facility Name
UCI
City
Irvine
State/Province
California
ZIP/Postal Code
92668
Country
United States
Facility Name
USC
City
Los Angeles
State/Province
California
ZIP/Postal Code
90033
Country
United States
Facility Name
UCSD
City
San Diego
State/Province
California
ZIP/Postal Code
92103
Country
United States
Facility Name
Santa Clara Valley Medical Center
City
San Jose
State/Province
California
ZIP/Postal Code
95128
Country
United States
Facility Name
Harbor-UCLA Medical Center
City
Torrance
State/Province
California
ZIP/Postal Code
90502
Country
United States

12. IPD Sharing Statement

Citations:
Citation
1. Best B, Rieg G, Sun S, Jain S, Kemper C, Diamond C, Hermes A, Haubrich R, Daar E, and California Collaborative Treatment Group (CCTG) 585 Team. Increased lopinavir concentrations on once-daily tablets as compared with capsules and liquid formulations. 15th Conference on Retroviruses and Opportunistic Infections; February 3-6, 2008; Boston, MA. Abstract 766a. 2. CDB088 Abstract Switching to once-daily (QD) lopinavir/ritonavir (LPV/r) liquid (Liq), capsules (caps) and tablets (tabs): a randomized, ppen label, cross-over study (CCTG 585). 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention; Cape Town 2009 G. Rieg1, S. Jain2, S. Sun2, R. Larsen3, C. Kemper4, C. Diamond5, S. Schneider6, D. Shamblaw7, A. Hermes8, R. Haubrich9, E. Daar10, California Collaborative Treatment Group (CCTG)
Results Reference
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A Multicenter Study to Assess the Tolerability of Once Daily Lopinavir/Ritonavir (LPV/r) Liquid Versus Capsules

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