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Dual Therapy With Boosted Darunavir + Dolutegravir (Dualis)

Primary Purpose

HIV-Infection

Status
Completed
Phase
Phase 3
Locations
Germany
Study Type
Interventional
Intervention
Prezista
Norvir
Tivicay
Truvada
Kivexa
Sponsored by
Technical University of Munich
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for HIV-Infection

Eligibility Criteria

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

Inclusion Criteria:

  • Age ≥ 18 years
  • HIV-1 infection with HIV-1 RNA < 50 cps/ml at screening and within a period of 24 weeks prior to screening with one accepted blip of HIV-1 RNA < 200 cps/ml and well-tolerated antiretroviral therapy of 2 NRTI in combination with DRV/r.
  • No known genotypic DRV- or integrase inhibitor-related HIV resistance
  • Signed written informed consent
  • Documented negative HLA B*57:01 (only in case of Abacavir-containing ART)
  • A female subject may be eligible to enter and participate in the study if she:

    • is of non-child-bearing potential defined as either post-menopausal (12 months of spontaneous amenorrhea and ≥ 45 years of age) or physically incapable of becoming pregnant with documented tubal ligation, hysterectomy or bilateral oophorectomy or
    • is of child-bearing potential with a negative pregnancy test at both screening and Day 1 and agrees to use one of the following methods of contraception to avoid pregnancy:
  • Complete abstinence from penile-vaginal intercourse from 2 weeks prior to administration of IMP, throughout the study, and for at least 2 weeks after discontinuation of all study medications
  • Double barrier method (male condom/spermicide, male condom/diaphragm, diaphragm/spermicide)
  • Male partner sterilization confirmed prior to the female subject's entry into the study, and this male is the sole partner for that subject
  • Approved hormonal contraception without DRV/r interactions and a barrier method
  • Any other method with published data showing that the expected failure rate is <1% per year. Any contraception method must be used consistently, in accordance with the approved product label and for at least 2 weeks after discontinuation of IMP.

Exclusion Criteria:

  • Pregnant women and nursing mothers
  • Chronic HBV infection (HBsAg and/or HBV DNA positive)
  • Any evidence of a Center for Disease Control and Prevention (CDC) Category C disease at screening, except cutaneous Kaposi's sarcoma not requiring systemic therapy. Historical or current CD4 cell counts < 200 cells/mm3 or historic CDC C diseases are not exclusionary
  • History or presence of allergy to the study drugs or their components
  • Subject has creatinine clearance of <50 mL/min by MDRD eGFR calculation
  • Alanine aminotransferase (ALT) ≥ 5 times the upper limit of normal (ULN), OR ALT ≥ 3xULN and bilirubin ≥ 1.5xULN (with >35% direct bilirubin)
  • Unstable liver disease (as defined by the presence of ascites, encephalopathy, coagulopathy, hypoalbuminemia, esophageal or gastric varices, or persistent jaundice), known biliary abnormalities (with the exception of Gilbert's syndrome or asymptomatic gallstones)
  • Subjects with severe hepatic impairment (Class B or greater) as determined by Child-Pugh classification
  • Anticipated need for interferon-based Hepatitis C virus (HCV) therapy during the study
  • Participation in other interventional clinical trials at the same time
  • Persons with any kind of dependency on the investigator or employed by the sponsor or investigator
  • Persons held in an institution by legal or official order
  • Imprisoned people, people requiring in-house treatment for psychiatric disorders or people who are unable to give informed consent

Sites / Locations

  • Klinikum rechts der Isar

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

A

B

Arm Description

Prezista & Norvir & Tivicay

Prezista & Norvir & Truvada or Prezista & Norvir & Kivexa

Outcomes

Primary Outcome Measures

number (%) of patients with fully suppressed HIV RNA < 50 cps/ml at week 48

Secondary Outcome Measures

Full Information

First Posted
June 15, 2015
Last Updated
April 9, 2019
Sponsor
Technical University of Munich
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1. Study Identification

Unique Protocol Identification Number
NCT02486133
Brief Title
Dual Therapy With Boosted Darunavir + Dolutegravir
Acronym
Dualis
Official Title
A Prospective, Multicenter, Randomized, Open-label Trial to Assess the Safety, Tolerability and Efficacy of Dual Therapy With Boosted Darunavir + Dolutegravir When Switching From Standard of Care ART in HIV-patients With Sustained Virological Suppression: The DUALIS Study
Study Type
Interventional

2. Study Status

Record Verification Date
April 2019
Overall Recruitment Status
Completed
Study Start Date
July 2015 (Actual)
Primary Completion Date
May 31, 2018 (Actual)
Study Completion Date
May 31, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Technical University of Munich

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
A switch strategy to investigate whether a dual therapy with Ritonavir-boosted (RTV) Darunavir (DRV) + Dolutegravir (DTG) over 48 weeks is non-inferior to a continuous standard of care therapy with RTV-boosted DRV in combination with 2 Nucleosidic Reverse Transcriptase Inhibitors (NRTIs) in HIV patients, who are on a stable antiretroviral therapy (ART) with RTV-boosted DRV in combination with 2 NRTIs.
Detailed Description
Modern combination antiretroviral therapy (cART) leads to well-controlled HIV infection with a potentially normal life expectancy. Nucleosidic reverse transcriptase inhibitors (NRTIs) play a major role as "ART backbone" and are essential antiretroviral agents according to current European and WHO HIV treatment guidelines. However, NRTI use can be associated with substantial side effects, e.g. bone and kidney toxicity, lipotoxicity and mitochondrial toxicity and can put patients at serious risk. Especially long-term NRTI-exposure is a risk factor for these often cumulative side effects, since the standard of care (SOC) therapy with the different NRTIs consists of the combination of multiple substances. Furthermore NRTI resistances may emerge over time and limit treatment options for pre-treated HIV patients. As a consequence, alternative NRTI free (so called "nuke sparing") therapy options have been evaluated in different studies but were associated with less virologic therapeutic success and higher rates of therapy induced resistance compared to standard regimens in ART naïve patients. This is particularly true for patients with a high baseline viral load. As an alternative to NRTI-based therapy options, Ritonavir-boosted protease inhibitor (PI/r)-based nuke-sparing dual therapies have been studied widely, mostly in combination with the integrase inhibitor (INI) Raltegravir (RAL). In this setting, the PI was not fully capable to prevent the development of INI resistant viruses. The HIV protease inhibitor Darunavir (DRV) and the novel INI Dolutegravir (DTG) are both very potent anchor drugs with a high barrier to resistance. Due to a favourable side-effect profile, a once-daily (QD) formulation and its virological potency, DRV is currently one of the most frequently used PIs in Europe and the USA. In addition, the new, once-daily administrable integrase inhibitor DTG showed an excellent tolerability profile as well as a high resistance barrier. The nuke-free combination of DTG (50 mg) with the Ritonavir (/r)- or Cobicistat-boosted protease inhibitor DRV (800 mg) may offer a favorable safety and efficacy profile with the advantage of QD-dosing.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
269 (Actual)

8. Arms, Groups, and Interventions

Arm Title
A
Arm Type
Experimental
Arm Description
Prezista & Norvir & Tivicay
Arm Title
B
Arm Type
Active Comparator
Arm Description
Prezista & Norvir & Truvada or Prezista & Norvir & Kivexa
Intervention Type
Drug
Intervention Name(s)
Prezista
Other Intervention Name(s)
Darunavir
Intervention Description
once daily
Intervention Type
Drug
Intervention Name(s)
Norvir
Other Intervention Name(s)
Ritonavir
Intervention Description
once daily
Intervention Type
Drug
Intervention Name(s)
Tivicay
Other Intervention Name(s)
Dolutegravir
Intervention Description
once daily
Intervention Type
Drug
Intervention Name(s)
Truvada
Other Intervention Name(s)
Tenofovir disaproxil fumarat/emtricitabine
Intervention Description
once daily
Intervention Type
Drug
Intervention Name(s)
Kivexa
Other Intervention Name(s)
Abacavir/Lamivudine
Intervention Description
once daily
Primary Outcome Measure Information:
Title
number (%) of patients with fully suppressed HIV RNA < 50 cps/ml at week 48
Time Frame
48 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age ≥ 18 years HIV-1 infection with HIV-1 RNA < 50 cps/ml at screening and within a period of 24 weeks prior to screening with one accepted blip of HIV-1 RNA < 200 cps/ml and well-tolerated antiretroviral therapy of 2 NRTI in combination with DRV/r. No known genotypic DRV- or integrase inhibitor-related HIV resistance Signed written informed consent Documented negative HLA B*57:01 (only in case of Abacavir-containing ART) A female subject may be eligible to enter and participate in the study if she: is of non-child-bearing potential defined as either post-menopausal (12 months of spontaneous amenorrhea and ≥ 45 years of age) or physically incapable of becoming pregnant with documented tubal ligation, hysterectomy or bilateral oophorectomy or is of child-bearing potential with a negative pregnancy test at both screening and Day 1 and agrees to use one of the following methods of contraception to avoid pregnancy: Complete abstinence from penile-vaginal intercourse from 2 weeks prior to administration of IMP, throughout the study, and for at least 2 weeks after discontinuation of all study medications Double barrier method (male condom/spermicide, male condom/diaphragm, diaphragm/spermicide) Male partner sterilization confirmed prior to the female subject's entry into the study, and this male is the sole partner for that subject Approved hormonal contraception without DRV/r interactions and a barrier method Any other method with published data showing that the expected failure rate is <1% per year. Any contraception method must be used consistently, in accordance with the approved product label and for at least 2 weeks after discontinuation of IMP. Exclusion Criteria: Pregnant women and nursing mothers Chronic HBV infection (HBsAg and/or HBV DNA positive) Any evidence of a Center for Disease Control and Prevention (CDC) Category C disease at screening, except cutaneous Kaposi's sarcoma not requiring systemic therapy. Historical or current CD4 cell counts < 200 cells/mm3 or historic CDC C diseases are not exclusionary History or presence of allergy to the study drugs or their components Subject has creatinine clearance of <50 mL/min by MDRD eGFR calculation Alanine aminotransferase (ALT) ≥ 5 times the upper limit of normal (ULN), OR ALT ≥ 3xULN and bilirubin ≥ 1.5xULN (with >35% direct bilirubin) Unstable liver disease (as defined by the presence of ascites, encephalopathy, coagulopathy, hypoalbuminemia, esophageal or gastric varices, or persistent jaundice), known biliary abnormalities (with the exception of Gilbert's syndrome or asymptomatic gallstones) Subjects with severe hepatic impairment (Class B or greater) as determined by Child-Pugh classification Anticipated need for interferon-based Hepatitis C virus (HCV) therapy during the study Participation in other interventional clinical trials at the same time Persons with any kind of dependency on the investigator or employed by the sponsor or investigator Persons held in an institution by legal or official order Imprisoned people, people requiring in-house treatment for psychiatric disorders or people who are unable to give informed consent
Facility Information:
Facility Name
Klinikum rechts der Isar
City
Munich
ZIP/Postal Code
81675
Country
Germany

12. IPD Sharing Statement

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Dual Therapy With Boosted Darunavir + Dolutegravir

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