KONCERT A Kaletra ONCE Daily Randomised Trial of the Pharmacokinetics, Safety and Efficacy of Twice-daily Versus Once-daily Lopinavir/Ritonavir Tablets Dosed by Weight as Part of Combination Antiretroviral Therapy in Human Immunodeficiency Virus-1 (HIV-1) Infected Children (PENTA 18) - Full Text View

Purpose

The trial will evaluate the pharmacokinetics, safety, efficacy and acceptability of twice- and once-daily dosing of lopinavir/ritonavir tablets (Kaletra) dosed by weight in HIV-1 infected children who are currently taking lopinavir/ritonavir as part of their combination antiretroviral therapy and who are currently achieving virological suppression (<50 copies/ml). Specifically:

To confirm weight-based dosing recommendations by evaluating the pharmacokinetics of twice-daily lopinavir/ritonavir half strength formulation tablets dosed on body weight and comparing to historical adult and paediatric data of pharmacokinetics of lopinavir/ritonavir soft gel capsules and oral solution respectively (1, 2).
To compare the pharmacokinetics of twice-daily lopinavir/ritonavir tablets with once-daily dosing in the same children.
To evaluate whether once-daily dosing of lopinavir/ritonavir is comparable to twice-daily dosing in terms of virological suppression at 48 weeks. Adherence and acceptability will also be compared.

Condition	Intervention	Phase
Antiretroviral Therapy in HIV-1 Infected Children	Drug: Kaletra dosed once daily Drug: kaletra dosed twice daily	Phase 2 Phase 3

Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Pharmacokinetics Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Treatment
Official Title:	KONCERT A Kaletra ONCE Daily Randomised Trial of the Pharmacokinetics, Safety and Efficacy of Twice-daily Versus Once-daily Lopinavir/Ritonavir Tablets Dosed by Weight as Part of Combination Antiretroviral Therapy in Human Immunodeficiency Virus-1 (HIV-1) Infected Children (PENTA 18)

Resource links provided by NLM:

Genetics Home Reference related topics: complement factor I deficiency

MedlinePlus related topics: HIV/AIDS

Drug Information available for: Ritonavir Lopinavir

U.S. FDA Resources

Further study details as provided by PENTA Foundation:

Primary Outcome Measures:

To evaluate whether once-daily dosing of lopinavir/ritonavir is comparable to twice-daily dosing in terms of virological suppression. This is measured by HIV-1 RNA ≥50 copies/ml (confirmed). [ Time Frame: week 48 ] [ Designated as safety issue: No ]
To evaluate whether once-daily dosing of lopinavir/ritonavir is comparable to twice-daily dosing in terms of virological suppression. This is measured by HIV-1 Ribonucleic acid (RNA) ≥50 copies/ml (confirmed).
To evaluate whether once-daily dosing of lopinavir/ritonavir is comparable to twice-daily dosing in terms of virological suppression. This is measured by HIV-1 RNA ≥50 copies/ml (confirmed). [ Time Frame: Week 36 ] [ Designated as safety issue: No ]
To evaluate whether once-daily dosing of lopinavir/ritonavir is comparable to twice-daily dosing in terms of virological suppression. This is measured by HIV-1 RNA ≥50 copies/ml (confirmed).
To evaluate whether once-daily dosing of lopinavir/ritonavir is comparable to twice-daily dosing in terms of virological suppression. This is measured by HIV-1 RNA ≥50 copies/ml (confirmed). [ Time Frame: week 24 ] [ Designated as safety issue: No ]
To evaluate whether once-daily dosing of lopinavir/ritonavir is comparable to twice-daily dosing in terms of virological suppression. This is measured by HIV-1 RNA ≥50 copies/ml (confirmed).
To evaluate whether once-daily dosing of lopinavir/ritonavir is comparable to twice-daily dosing in terms of virological suppression. This is measured by HIV-1 RNA ≥50 copies/ml (confirmed). [ Time Frame: week 12 ] [ Designated as safety issue: No ]
To evaluate whether once-daily dosing of lopinavir/ritonavir is comparable to twice-daily dosing in terms of virological suppression. This is measured by HIV-1 RNA ≥50 copies/ml (confirmed).
To evaluate whether once-daily dosing of lopinavir/ritonavir is comparable to twice-daily dosing in terms of virological suppression. This is measured by HIV-1 RNA ≥50 copies/ml (confirmed). [ Time Frame: week 8 ] [ Designated as safety issue: No ]
To evaluate whether once-daily dosing of lopinavir/ritonavir is comparable to twice-daily dosing in terms of virological suppression. This is measured by HIV-1 RNA ≥50 copies/ml (confirmed).
To evaluate whether once-daily dosing of lopinavir/ritonavir is comparable to twice-daily dosing in terms of virological suppression. This is measured by HIV-1 RNA ≥50 copies/ml (confirmed). [ Time Frame: week 4 ] [ Designated as safety issue: No ]
To evaluate whether once-daily dosing of lopinavir/ritonavir is comparable to twice-daily dosing in terms of virological suppression. This is measured by HIV-1 RNA ≥50 copies/ml (confirmed).
To compare the pharmacokinetics of twice-daily lopinavir/ritonavir tablets with once-daily dosing in the same children [ Time Frame: week 4 ] [ Designated as safety issue: No ]
Area under the curve (AUC), minimum observed plasma concentration (Cmin) and maximum observed plasma concentration (Cmax) values of lopinavir after once-daily and twice-daily dosing (in the same children)

Secondary Outcome Measures:

To evaluate whether once-daily dosing of lopinavir/ritonavir is comparable to twice-daily dosing in terms of virological suppression. This is measured by HIV-1 RNA <400/<50 copies/ml. [ Time Frame: week 24 ] [ Designated as safety issue: No ]
To evaluate whether once-daily dosing of lopinavir/ritonavir is comparable to twice-daily dosing in terms of virological suppression. This is measured by HIV-1 RNA <400/<50 copies/ml.
To evaluate whether once-daily dosing of lopinavir/ritonavir is comparable to twice-daily dosing in terms of virological suppression. This is measured by HIV-1 RNA <400/<50 copies/ml. [ Time Frame: week 48 ] [ Designated as safety issue: No ]
To evaluate whether once-daily dosing of lopinavir/ritonavir is comparable to twice-daily dosing in terms of virological suppression. This is measured by HIV-1 RNA <400/<50 copies/ml.
Acceptability and adherence to once-daily versus twice-daily dosing of lopinavir/ritonavir tablets [ Time Frame: week 48 ] [ Designated as safety issue: No ]
Acceptability and adherence to once-daily versus twice-daily dosing of lopinavir/ritonavir tablets, assessed by patient/carer completed questionnaires

Estimated Enrollment:	160
Study Start Date:	August 2010
Estimated Primary Completion Date:	February 2012 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Experimental: QD kaletra Once daily kaletra	Drug: Kaletra dosed once daily Lopinavir/Ritonavir tablets. Dose = 200/50mg or 100/25mg. Frequency = once daily.
Active Comparator: BID kaletra twice daily dose of kaletra	Drug: kaletra dosed twice daily Lopinavir/Ritonavir tablets. Dose = 200/50mg or 100/25mg. Frequency = twice daily.

Eligibility

Ages Eligible for Study:	up to 18 Years
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

aged <18 years (up to 18th birthday) with confirmed HIV-1 infection
weight ≥15 kg
able to swallow tablets
stable (i.e. CD4 not declining) on a combination antiretroviral regimen that has included lopinavir/ritonavir for at least 24 weeks
taking lopinavir/ritonavir dosed twice-daily and be willing at the screening visit to change to tablet formulation (if not currently taking tablets) and to change the lopinavir/ritonavir dose to follow the recommended FDA dosing plan based on body weight bands as necessary (see 7.2.2); if participating in the PK study*, be willing at the screening visit to change to lopinavir/ritonavir half strength formulation tablets (100/25mg) only, dosed twice-daily and change the lopinavir/ritonavir dose to follow the recommended FDA dosing plan based on body weight bands as necessary (see 7.2.1)
viral suppression (HIV-1 RNA <50 copies/ml) for at least the prior 24 weeks (minimum of 2 measurements).
children and caregivers willing to participate in the PK study if they are among a minimum of the first 16 children enrolled in each body weight band in the trial, including a second PK assessment if randomised to switch to once-daily lopinavir/ritonavir.
parents/carers and children, where applicable, give informed written consent

Exclusion Criteria:

children on an antiretroviral regimen that includes a non-nucleoside reverse transcriptase inhibitor (NNRTI), fosamprenavir or nelfinavir
children who have previously failed virologically on a protease inhibitor (PI) containing regimen (where virological failure is defined as two successive HIV-1 RNA results>1000 copies/ml (confirmed) more than 24 weeks after starting highly active antiretroviral therapy (HAART), i.e changes for toxicity are not counted as failure)
acute illness
abnormal renal or liver function (grade 3 or above)
receiving concomitant therapy except for prophylaxis; Some treatments may be allowed, but must first be discussed with a trial medical expert
pregnancy or risk of pregnancy in females of child bearing potential

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT01196195

Contacts

Contact: E.G. Hermione Lyall, MD

+44 (0) 20 7886 1013

hermione.lyall@imperial.nhs.uk

Locations

Germany
Charite University Hospital Berlin	Recruiting
Berlin, Germany
Contact: Cornelia Feiterna-Sperling
Department of Pediatric Oncology Hematology and Immunology KA02	Recruiting
Dusseldorf, Germany
Contact: Petra Lankisch
J W Goethe University	Recruiting
Frankfurt, Germany
Contact: Christoph Konigs
Immundefekt-Ambulanz, Dr. von Haunersches Kinderspital	Recruiting
Munich, Germany
Contact: Gundula Notheis
Ireland
Our Lady's Children's Hospital	Recruiting
Dublin, Ireland
Contact: Karina Butler
Netherlands
Emma Childrens Hospital	Recruiting
Amsterdam, Netherlands
Contact: Henriette Scherpbier
UMC St. Radboud	Recruiting
Nijmegen, Netherlands
Contact: Ronald de Groot
Thailand
Program for HIV Prevention and Treatment (PHPT)/IRD 174	Recruiting
Changklan, Muang, Chiang Mai, Thailand, 50100
Contact: Tim Cressey
Sub-Investigator: Tim Cressey, MD
HIV-NAT Thai Red Cross AIDS Research Centre	Recruiting
Bangkok, Thailand
Contact: Jintanat Ananworanich
United Kingdom
Birmingham Heartlands Hospital	Recruiting
Birmingham, United Kingdom
Contact: Scott Hackett
University Hospital Bristol	Recruiting
Bristol, United Kingdom
Contact: Jolanta Bernatoniene
St. Mary's Hospital	Recruiting
London, United Kingdom
Contact: Hermione Lyall
King's College Hospital	Recruiting
London, United Kingdom
Contact: Colin Ball
Great Ormond Street Hospital	Recruiting
London, United Kingdom
Contact: Delane Shingadia
Evelina Children's Hospital	Recruiting
London, United Kingdom
Contact: Esse Menson
Nottingham City Hospital Campus	Recruiting
Nottingham, United Kingdom
Contact: Joanna Smith
John Radcliffe Hospital	Recruiting
Oxford, United Kingdom
Contact: Andrew Pollard

Sponsors and Collaborators

PENTA Foundation

Medical Research Council

French National Institute for Health and Medical Research-French National Agency for Research on AIDS and Viral Hepatitis (Inserm-ANRS)

More Information

Additional Information:

Related Info This link exits the ClinicalTrials.gov site

No publications provided

Responsible Party:	PENTA Foundation
ClinicalTrials.gov Identifier:	NCT01196195 History of Changes
Other Study ID Numbers:	KONCERT protocol, version 1.6, 2009-013648-35
Study First Received:	August 16, 2010
Last Updated:	February 2, 2012
Health Authority:	United Kingdom: Medicines and Healthcare Products Regulatory Agency

Keywords provided by PENTA Foundation:

antiretroviral therapy
child
HIV-1

Additional relevant MeSH terms:

Acquired Immunodeficiency Syndrome
HIV Infections
Anti-Infective Agents
Immunologic Deficiency Syndromes
Lentivirus Infections
Retroviridae Infections
RNA Virus Infections
Virus Diseases
Sexually Transmitted Diseases, Viral
Sexually Transmitted Diseases
Slow Virus Diseases
Immune System Diseases

Ritonavir
Lopinavir
HIV Protease Inhibitors
Protease Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Anti-HIV Agents
Anti-Retroviral Agents
Antiviral Agents
Therapeutic Uses

ClinicalTrials.gov processed this record on May 16, 2013