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Efficacy Study of Substitution of Darunavir/Ritonavir (DRV/r) for Dual-boosted Protease Inhibitors (DVD)

Primary Purpose

HIV Infections

Status
Completed
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
Darunavir (DRV/r)
continue on current dual boosted PI
Sponsored by
Community Research Initiative of New England
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for HIV Infections focused on measuring HIV/AIDS, darunavir, Protease inhibitors, Dual boosted, Treatment experienced

Eligibility Criteria

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

Inclusion Criteria:

  • Age 18 years or older
  • Treatment with a stable antiretroviral regimen containing two protease inhibitors, one additional FDA-licensed agent from another class (except NNRTIs) and a boosting dosage of ritonavir (100 BID or QD) for at least 12 weeks prior to screening
  • No plans to make any changes in HIV treatment regimen (other than those required by study) in the next 48 weeks.
  • HIV-1 RNA < 400 copies/ml based on the most recent value done as part of routine care at least 12 weeks prior to screening; and < 400 at screening
  • Any CD4 count is allowed
  • Written informed consent to participate

Exclusion Criteria:

  • Current regimen includes an NNRTI
  • CDC Class C Illness diagnosed within 30 days of screening
  • Lab abnormalities as defined by a standardized grading scheme based on the DAIDS table
  • Any grade 3 or 4 toxicity with the following exceptions:

    • Pre-existing diabetes with glucose elevations ≥ grade 3
    • triglyceride or total cholesterol elevations ≥ grade 3
  • Clinical or laboratory evidence of clinically significant liver impairment/dysfunction, disease or cirrhosis Note: Individuals co-infected with chronic hepatitis B or C will be allowed to enter the trial if their condition is clinically stable. Individuals diagnosed with acute viral hepatitis at screening will not be allowed to enroll during acute phase.
  • Active substance abuse or significant psychiatric illness that in the opinion of the investigator might interfere with study compliance.
  • Use of any investigational agents 30 days prior to screening
  • Life expectancy < 6 months in the opinion of the investigator
  • Prior use of darunavir or known allergy to any of the components of darunavir
  • Breast feeding
  • Female subject of childbearing potential not using effective non-hormonal birth control methods or not willing to continue practicing these birth control methods from screening until the last trial related activity.

Note: Hormonal based contraception may not be reliable when taking darunavir, therefore to be eligible for this study, women of childbearing potential who may have vaginal intercourse should either:

  1. Use a double barrier method to prevent pregnancy (i.e., using a condom with either a diaphragm or cervical cap) Or
  2. Use hormonal based contraceptives in combination with a barrier contraceptive (i.e., male condom, diaphragm, cervical cap or female condom) Or
  3. Use an intra uterine device (IUD) in combination with a barrier contraceptive (i.e., male condom, diaphragm, cervical cap or female condom) Or
  4. Be non-heterosexually active, practice sexual abstinence or have a vasectomized partner (confirmed sterile).

Sites / Locations

  • Spectrum Medical Group
  • AIDS Healthcare Foundation
  • Orlando Immunology Center
  • Community Research Initiative of New England
  • Albany Medical Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

Switch to DRV/r

Continue on Current Dual Boosted PI

Arm Description

Switch to DRV/r at a dose of 600/100 BID for 48 weeks

Continue on current dual boosted PI until week 24. At week 24, participants will be allowed to cross over to the DRV/r arm provided that they have maintained virologic suppression (< 400 copies/ml) for the first 24-weeks of the study and are followed for an additional 24 weeks

Outcomes

Primary Outcome Measures

The Percentage of Participants With Successful Virologic Suppression
Amount of HIV RNA copies per ml blood collected from subjects as measured by the Ultra-sensitive HIV-1 PCR (Roche Cobas). Successful virologic suppression is defined as < 50 copies/ml blood. The result is the percentage of participants with successful virologic suppression.

Secondary Outcome Measures

Economic Impact of a Substitution of Dual Boosted PIs With DRV/r
To assess the economic impact of DRV/r substitution for dual boosted PIs, we compared the average wholesale acquisition costs for the drugs in US Dollars ($) per month. The wholesale acquisition cost in US dollars ($) for each ART regimen was determined and the difference between the cost for the experimental and control groups was calculated and reported as US dollar savings per month.
Lipid Fraction Results, Mean of the Change From Baseline to Week 24.
We collected fasting total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides from all participants in both arms of the study. We calculated the differences between the values at week 24 and baseline for the participants in both arms. We reported the mean of the change from baseline to week 24.
Treatment Satisfaction (+3, Much More Satisfied Now to -3, Much Less Satisfied Now)
Participants in the experimental arm completed treatment satisfaction questionnaires at 24 weeks, and the control arm at 48 weeks (24 weeks after mid-study crossover to boosted darunavir). The questionnaires used numeric satisfaction scales (+3 much more satisfied now to -3 much less satisfied now). We reported the median and ranges for each question for each study arm.

Full Information

First Posted
October 11, 2007
Last Updated
July 18, 2017
Sponsor
Community Research Initiative of New England
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1. Study Identification

Unique Protocol Identification Number
NCT00543101
Brief Title
Efficacy Study of Substitution of Darunavir/Ritonavir (DRV/r) for Dual-boosted Protease Inhibitors
Acronym
DVD
Official Title
A Randomized, Controlled Trial to Evaluate the Efficacy of Substituting Darunavir/Ritonavir (DRV/r) for Dual-boosted Protease Inhibitors in Individuals With Virologic Suppression for at Least 12 Weeks
Study Type
Interventional

2. Study Status

Record Verification Date
July 2017
Overall Recruitment Status
Completed
Study Start Date
October 2007 (undefined)
Primary Completion Date
February 2010 (Actual)
Study Completion Date
February 2010 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Community Research Initiative of New England

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study will evaluate patients who have achieved virologic suppression (< 400 copies/mL) on any dual protease inhibitor (PI) combination, to determine whether patients can substitute both PIs with the single boosted PI darunavir given 600/100 ritonavir (RTV) twice daily (BID) and maintain comparable virologic suppression (% < 50 c/mL) for 24 weeks.
Detailed Description
The purpose of this study is to determine if patients who have achieved virologic suppression (< 400 copies/mL) on any dual PI combination, can substitute both PIs with the single boosted PI darunavir given 600/100 rtv bid and maintain comparable virologic suppression (% < 50 c/mL) for 24 weeks. Randomized, non-blinded, multicenter, 48 week, controlled trial to assess the non-inferiority of substituting DRV/r for a dual boosted PI combination in patients with stable virologic suppression on a regimen containing a dual boosted PI combination plus at least one additional FDA-licensed antiretroviral agent from another class. Participants will be randomized (1:1) to one of the included treatment arms.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
HIV Infections
Keywords
HIV/AIDS, darunavir, Protease inhibitors, Dual boosted, Treatment experienced

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Switch to DRV/r
Arm Type
Active Comparator
Arm Description
Switch to DRV/r at a dose of 600/100 BID for 48 weeks
Arm Title
Continue on Current Dual Boosted PI
Arm Type
Active Comparator
Arm Description
Continue on current dual boosted PI until week 24. At week 24, participants will be allowed to cross over to the DRV/r arm provided that they have maintained virologic suppression (< 400 copies/ml) for the first 24-weeks of the study and are followed for an additional 24 weeks
Intervention Type
Drug
Intervention Name(s)
Darunavir (DRV/r)
Intervention Description
Switch to DRV/r at a dose of 600/100 BID for 48 weeks
Intervention Type
Drug
Intervention Name(s)
continue on current dual boosted PI
Intervention Description
Continue on current dual boosted PI until week 24. At week 24, participants will be allowed to cross over to the DRV/r arm provided that they have maintained virologic suppression (< 400 copies/ml) for the first 24-weeks of the study and be followed for an additional 24 weeks
Primary Outcome Measure Information:
Title
The Percentage of Participants With Successful Virologic Suppression
Description
Amount of HIV RNA copies per ml blood collected from subjects as measured by the Ultra-sensitive HIV-1 PCR (Roche Cobas). Successful virologic suppression is defined as < 50 copies/ml blood. The result is the percentage of participants with successful virologic suppression.
Time Frame
24 weeks
Secondary Outcome Measure Information:
Title
Economic Impact of a Substitution of Dual Boosted PIs With DRV/r
Description
To assess the economic impact of DRV/r substitution for dual boosted PIs, we compared the average wholesale acquisition costs for the drugs in US Dollars ($) per month. The wholesale acquisition cost in US dollars ($) for each ART regimen was determined and the difference between the cost for the experimental and control groups was calculated and reported as US dollar savings per month.
Time Frame
48 weeks
Title
Lipid Fraction Results, Mean of the Change From Baseline to Week 24.
Description
We collected fasting total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides from all participants in both arms of the study. We calculated the differences between the values at week 24 and baseline for the participants in both arms. We reported the mean of the change from baseline to week 24.
Time Frame
baseline and 24 weeks
Title
Treatment Satisfaction (+3, Much More Satisfied Now to -3, Much Less Satisfied Now)
Description
Participants in the experimental arm completed treatment satisfaction questionnaires at 24 weeks, and the control arm at 48 weeks (24 weeks after mid-study crossover to boosted darunavir). The questionnaires used numeric satisfaction scales (+3 much more satisfied now to -3 much less satisfied now). We reported the median and ranges for each question for each study arm.
Time Frame
24 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age 18 years or older Treatment with a stable antiretroviral regimen containing two protease inhibitors, one additional FDA-licensed agent from another class (except NNRTIs) and a boosting dosage of ritonavir (100 BID or QD) for at least 12 weeks prior to screening No plans to make any changes in HIV treatment regimen (other than those required by study) in the next 48 weeks. HIV-1 RNA < 400 copies/ml based on the most recent value done as part of routine care at least 12 weeks prior to screening; and < 400 at screening Any CD4 count is allowed Written informed consent to participate Exclusion Criteria: Current regimen includes an NNRTI CDC Class C Illness diagnosed within 30 days of screening Lab abnormalities as defined by a standardized grading scheme based on the DAIDS table Any grade 3 or 4 toxicity with the following exceptions: Pre-existing diabetes with glucose elevations ≥ grade 3 triglyceride or total cholesterol elevations ≥ grade 3 Clinical or laboratory evidence of clinically significant liver impairment/dysfunction, disease or cirrhosis Note: Individuals co-infected with chronic hepatitis B or C will be allowed to enter the trial if their condition is clinically stable. Individuals diagnosed with acute viral hepatitis at screening will not be allowed to enroll during acute phase. Active substance abuse or significant psychiatric illness that in the opinion of the investigator might interfere with study compliance. Use of any investigational agents 30 days prior to screening Life expectancy < 6 months in the opinion of the investigator Prior use of darunavir or known allergy to any of the components of darunavir Breast feeding Female subject of childbearing potential not using effective non-hormonal birth control methods or not willing to continue practicing these birth control methods from screening until the last trial related activity. Note: Hormonal based contraception may not be reliable when taking darunavir, therefore to be eligible for this study, women of childbearing potential who may have vaginal intercourse should either: Use a double barrier method to prevent pregnancy (i.e., using a condom with either a diaphragm or cervical cap) Or Use hormonal based contraceptives in combination with a barrier contraceptive (i.e., male condom, diaphragm, cervical cap or female condom) Or Use an intra uterine device (IUD) in combination with a barrier contraceptive (i.e., male condom, diaphragm, cervical cap or female condom) Or Be non-heterosexually active, practice sexual abstinence or have a vasectomized partner (confirmed sterile).
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Calvin J Cohen, MD, MSc
Organizational Affiliation
CRI
Official's Role
Principal Investigator
Facility Information:
Facility Name
Spectrum Medical Group
City
Phoenix
State/Province
Arizona
ZIP/Postal Code
85012
Country
United States
Facility Name
AIDS Healthcare Foundation
City
Los Angeles
State/Province
California
ZIP/Postal Code
02319
Country
United States
Facility Name
Orlando Immunology Center
City
Orlando
State/Province
Florida
Country
United States
Facility Name
Community Research Initiative of New England
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02215
Country
United States
Facility Name
Albany Medical Center
City
Albany
State/Province
New York
ZIP/Postal Code
12208
Country
United States

12. IPD Sharing Statement

Links:
URL
http://www.crine.org
Description
Web page of CRI, the nonprofit research group sponsoring the study

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Efficacy Study of Substitution of Darunavir/Ritonavir (DRV/r) for Dual-boosted Protease Inhibitors

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