Nevirapine or Atazanavir/Ritonavir Given With Emtricitabine/Tenofovir in Human Immunodeficiency Virus (HIV)-1-infected Treatment Naive Adults
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Purpose
Primary purpose of this study is to compare the efficacy and safety of two different nevirapine (Viramune) dosing regimens (once daily (QD) and twice daily (BID) application) and of atazanavir/ritonavir (Reyataz/Norvir), all on an emtricitabine/tenofovir disoproxil fumarate (DF) (Truvada) background. Patients will receive either nevirapine (NVP) 200 mg twice daily, or NVP 400 mg once daily , or ritonavir-boosted atazanavir (ATZ/r), all in combination with emtricitabine (FTC) and tenofovir DF (TDF).
All patients receiving NVP will start at 200 mg once daily for 2 weeks, because it has been demonstrated that this lead-in dosing regimen reduces the frequency of NVP-induced rash. At Visit 3 (Week 2), patients increase the NVP dose to either 200 mg twice daily or to 400 mg once daily. Patients receiving ATZ/r will be treated with ATZ 300 mg once daily, boosted by 100 mg ritonavir (RTV) once daily. Background antiretroviral therapy for all patients consists of one tablet of Truvada. Treatment duration is 48 weeks (primary endpoint) with an extension to 144 weeks. Patients may also participate in the metabolic sub-study, comparing NVP and ATZ/r for signs and symptoms of lipodystrophy and serum lipid/glycaemic abnormalities.
| Condition | Intervention | Phase |
|---|---|---|
|
HIV Infections |
Drug: nevirapine bid Drug: nevirapine qd Drug: atazanavir |
Phase 3 |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Treatment |
| Official Title: | Randomized, Open Label Study Evaluating the Lipid Profile Difference and Efficacy of a Combined Therapy Including Tenofovir, Emtricitabine + Atazanavir / r or NVP in Naive HIV - 1 Infected Patients. |
- Treatment Response at Week 48 [ Time Frame: From baseline to Week 48 ] [ Designated as safety issue: No ]Treatment response is defined as a viral load (VL) <50 copies/mL measured at two consecutive visits prior to Week 48 and without subsequent rebound or change of antiretroviral (ARV) therapy prior to Week 48.
- Treatment Response at Week 48 (TLOVR Algorithm) [ Time Frame: From baseline to Week 48 ] [ Designated as safety issue: No ]Treatment response is defined as a VL <50 copies/mL measured at two consecutive visits up to Week 48 and without subsequent rebound or change of ARV therapy up to Week 48, based on time to loss of virologic response (TLOVR) algorithm, as a sensitivity analysis for the primary analysis.
- Proportion of Patients With VL < 50 Copies/ml [ Time Frame: From baseline to Weeks 4, 8, 12, 24, 36, 48, 60, 72, 84, 96, 108, 120, 132 and 144/EOT ] [ Designated as safety issue: No ]VL <50 copies/mL among observed patients on treatment at each visit, with the final visit at Week 144 or end of trial (EOT) for the patient
- Proportion of Patients With VL < 400 Copies/ml [ Time Frame: From baseline to Weeks 4, 8, 12, 24, 36, 48, 60, 72, 84, 96, 108, 120, 132 and 144/EOT ] [ Designated as safety issue: No ]VL <400 copies/mL among observed patients on treatment at each visit, with the final visit at Week 144 or end of trial (EOT)
- Change in CD4+ Count From Baseline [ Time Frame: From baseline to Weeks 4, 8, 12, 24, 36, 48, 60, 72, 84, 96, 108, 120, 132 and 144/EOT ] [ Designated as safety issue: No ]Change in CD4+ cell count from baseline among patients on treatment at each visit, with the final visit at Week 144 or EOT
- Change in Framingham Score From Baseline [ Time Frame: From baseline to Weeks 48, 96 and 144/EOT ] [ Designated as safety issue: No ]Change in the estimated risk of cardiovascular disease using the Framingham algorithm from baseline to after 48, 96 and 144 weeks, last observation carried forward (LOCF). The score is based on age, gender, systolic blood pressure, total cholesterol, high density lipoprotein cholesterol and smoking status. Scores range from 0 to 21 with higher scores indicating a greater risk.
- Change in Mental Health Summary (MHS) Score From Baseline [ Time Frame: From baseline to Weeks 48, 96 and 144/EOT ] [ Designated as safety issue: No ]Quality of life (QoL) assessment by change in MHS score from baseline to after 48, 96 and 144 weeks (observed cases), from the Medical Outcomes Study HIV Health Survey (MOS-HIV), a 35-item self-administered questionnaire including 10 scales covering: health perceptions, pain, physical functioning, role functioning, social and cognitive functioning, mental health, energy/fatigue, health distress, and QoL. The MHS is a weighted average of the 10 scales and ranges from 0 to 100 with higher scores indicating better QoL.
- Change in Physical Health Summary (PHS) Score From Baseline [ Time Frame: From baseline to Weeks 48, 96 and 144/EOT ] [ Designated as safety issue: No ]QoL assessment by change in PHS score from baseline to after 48, 96 and 144 weeks (observed cases), from the MOS-HIV, a 35-item self-administered questionnaire including 10 scales covering: health perceptions, pain, physical functioning, role functioning, social and cognitive functioning, mental health, energy/fatigue, health distress, and QoL. The PHS is a weighted average of the 10 scales and ranges from 0 to 100 with higher scores indicating better QoL.
- Number of Patients Hospitalized [ Time Frame: From baseline to Week 24, Week 24 to 48, Week 48 to 96, and Week 96 to 144/EOT ] [ Designated as safety issue: No ]Cost effectiveness assessment by number of patients hospitalized
- Non-scheduled Physician Visits [ Time Frame: From baseline to Week 24, Week 24 to 48, Week 48 to 96, and Week 96 to 144/EOT ] [ Designated as safety issue: No ]Cost effectiveness assessment by number of patients with non-scheduled physician visits
- Genotypic Resistance Associated With Virologic Failure [ Time Frame: From baseline to Week 48 ] [ Designated as safety issue: No ]Number of treatment-emergent drug-associated substitutions in patients with virological failure up to Week 48. The total number of genotypic mutations in those patients who were virologic failures is given, not the number of patients with mutations.
- Treatment-emergent AIDS-defining Illness [ Time Frame: From baseline to Week 144 ] [ Designated as safety issue: No ]Treatment-emergent AIDS-defining illness (tr.-emerg. AIDS-def.illness) including worsening during treatment
- Treatment-emergent AIDS-defining Illness Leading to Death [ Time Frame: From baseline to Week 144 ] [ Designated as safety issue: No ]
- Lipodystrophy [ Time Frame: From baseline to Week 144 ] [ Designated as safety issue: No ]Number of patients with AE lipodystrophy
- Serum Lipid Abnormalities [ Time Frame: From baseline to Week 144 ] [ Designated as safety issue: No ]Number of patients with AE elevated serum lipids
- Glycaemic Abnormalities [ Time Frame: From baseline to Week 144 ] [ Designated as safety issue: No ]Number of patients with AE elevated serum glucose
| Enrollment: | 576 |
| Study Start Date: | October 2006 |
| Primary Completion Date: | February 2011 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Active Comparator: NVP bid
nevirapine (NVP) 200 mg BID in combination with emtricitabine (FTC) and tenofovir DF (TDF)
|
Drug: nevirapine bid
nevirapine twice daily
|
|
Experimental: NVP qd
nevirapine (NVP) 400 mg QD in combination with emtricitabine (FTC) and tenofovir DF (TDF)
|
Drug: nevirapine qd
nevirapine once daily
|
|
Active Comparator: ATZ/r
ritonavir-boosted atazanavir in combination with emtricitabine (FTC) and tenofovir DF (TDF)
|
Drug: atazanavir
atazanavir once daily
|
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion criteria:
Inclusion Criteria:
- Signed informed consent in accordance with Good Clinical Practice (GCP) and local regulatory requirements prior to trial participation
- HIV-1-infected males or females >= 18 years of age with positive serology confirmed by Western blot
- No previous antiretroviral treatment (of more than 7 days)
- Males with CD4+ counts of < 400 cells/mm3 and females with CD4+ counts of < 250 cells/mm3
- NVP- and ATZ/r susceptibility based on HIV-1 genotypic resistance report
- Adequate renal function defined as a calculated creatinine clearance (CLCr) >= 50 ml/min according to the Cockcroft-Gault formula
- Karnofsky score >= 70
- Acceptable medical history, as assessed by the investigator
Exclusion criteria:
Exclusion Criteria:
- Active drug abuse or chronic alcoholism at the investigator's discretion
- Hepatic cirrhosis stage Child-Pugh B or C
Female patients of child-bearing potential who:
- have a positive serum pregnancy test at screening or during the study,
- are breast feeding,
- are planning to become pregnant,
- are not willing to use a barrier method of contraception, or are not willing to use methods of contraception other than ethinyl estradiol containing oral contraceptives
- Laboratory parameters Division of Acquired Immunodeficiency Syndrome (DAIDS) > grade 2 (triglycerides > DAIDS grade 3; total cholesterol no restrictions)
- Active hepatitis B or C disease, defined as HBsAg-positive or Hepatitis C-Virus-Ribo Nucleic Acid (HCV-RNA)- positive with Aspartate Transaminase/Alanine Transaminase (AST/ALT) > 2.5x Upper Limit of Normal (ULN) (DAIDS grade 1)
- Hypersensitivity to any ingredients of the test products
- Have therapy with nephrotoxic drugs (e.g., aminoglycosides, amphotericin B, vancomycin, cidofovir, foscarnet, cisplatin, pentamidine, tacrolimus, cyclosporine) or potential competitors of renal excretion (e.g., cidofovir, acyclovir, valacyclovir, ganciclovir, valganciclovir, probenecid, high-dose non-steroidal anti-inflammatory drugs (i.e., ibuprofen)) within 3 months prior to study screening or are expected to receive these during the study
- Patients who are receiving other concomitant treatments which are not permitted
- Use of other investigational medications within 30 days before study entry or during the trial
- Use of immunomodulatory drugs within 30 days before study entry or during the trial (e.g., interferon, cyclosporin, hydroxyurea, interleukin 2, chronic treatment with prednisone)
- Patients with Progressive Multifocal Leukoencephalopathy (PML), Visceral Kaposi's Sarcoma (KS), and/or any lymphoma
- Any AIDS defining illness that is unresolved, symptomatic or not stable on treatment for at least 12 weeks at screening visit
- Patients who are receiving systemic treatment for malignant disease
Contacts and Locations
Show 68 Study Locations| Study Chair: | Boehringer Ingelheim | Boehringer Ingelheim Pharmaceuticals |
More Information
Additional Information:
No publications provided by Boehringer Ingelheim Pharmaceuticals
Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
| Responsible Party: | Boehringer Ingelheim Pharmaceuticals |
| ClinicalTrials.gov Identifier: | NCT00389207 History of Changes |
| Other Study ID Numbers: | 1100.1470, 2005-004330-40 |
| Study First Received: | October 17, 2006 |
| Results First Received: | January 13, 2012 |
| Last Updated: | May 18, 2012 |
| Health Authority: | Argentina: A.N.M.A.T. (Administracion Nacional de Medicamentos, Alimentos y Tecnologia Medica) Germany: Federal Institute for Drugs and Medical Devices Great Britain: MHRA Italy: Comitato Etico dell'Azienda Osp. Riuniti di Bergamo - Bergamo Mexico: Comision Federal para la Proteccion contra Riesgos Sanitarios (COFEPRIS) Poland: Office for Registration of Medicinal Products, Medical Devices and Biocidal Products Portugal: National Pharmacy and Medicines Institute Romania: National Medicines Agency, Bucharest Spain: Agencia Espanola del Medicamento y Productos Sanitarios Switzerland: Swissmedic Schweizerisches Heilmittelinstitut (Swiss Agency for Therapeutic Products) |
Additional relevant MeSH terms:
|
Acquired Immunodeficiency Syndrome HIV Infections Lentivirus Infections Retroviridae Infections RNA Virus Infections Virus Diseases Sexually Transmitted Diseases, Viral Sexually Transmitted Diseases Slow Virus Diseases Immunologic Deficiency Syndromes Immune System Diseases Nevirapine Tenofovir Tenofovir disoproxil |
Atazanavir Emtricitabine Anti-HIV Agents Anti-Retroviral Agents Antiviral Agents Anti-Infective Agents Therapeutic Uses Pharmacologic Actions Reverse Transcriptase Inhibitors Nucleic Acid Synthesis Inhibitors Enzyme Inhibitors Molecular Mechanisms of Pharmacological Action HIV Protease Inhibitors Protease Inhibitors |
ClinicalTrials.gov processed this record on May 22, 2013