Trial of Maraviroc (UK-427,857) in Combination With Optimized Background Therapy Versus Optimized Background Therapy Alone for the Treatment of Antiretroviral-Experienced NonCCR5-Tropic HIV-1 Infected Subjects

This study has been completed.
Sponsor:
Collaborator:
Pfizer
Information provided by:
ViiV Healthcare
ClinicalTrials.gov Identifier:
NCT00098748
First received: December 7, 2004
Last updated: November 19, 2010
Last verified: November 2010
  Purpose

Maraviroc (UK-427,857), a selective and reversible CCR5 co-receptor antagonist, has been shown to be active in vitro against a wide range of clinical isolates (including those resistant to existing classes). In HIV-1 infected patients in the United States, maraviroc (UK-427,857) is approved for use as part of combination antiretroviral treatment in treatment-experienced and treatment-naive adult subjects. At least 50% of treatment-experienced patients are infected with R5-tropic HIV-1 exclusively. However, even in patients infected with a dual tropic (R5 + X4) phenotype, a large proportion of the virus population still uses CCR5 exclusively. Thus, the purpose of this study is to evaluate the antiretroviral activity, and safety, of maraviroc (UK-427,857) (in combination with other agents) in HIV infected, treatment experienced patients who are failing their current antiretroviral regimen and not infected with R5-tropic virus exclusively. This study will involve more than 200 centers globally to achieve a total randomized subject population of 192 subjects. Patients will be randomly (1:1:1) assigned to one of three groups: Optimized Background Therapy [OBT (3-6 drugs based on treatment history and resistance testing)] + maraviroc (UK-427,857) 150 mg taken once daily, OBT + maraviroc (UK-427,857) 150 mg taken twice daily, or OBT alone. Randomization was stratified by Enfuvirtide use in OBT (yes/no) and Screening HIV-1 RNA level (viral load) (<100,000/≥ 100, 000 copies per milliliter [copies per mL]). The study will enroll over approximately a 9 month period with 48 weeks of treatment. Physical examinations will be performed at study entry, weeks 4, 8, 12, 16, 20, 24, 32, 40 and 48. Blood samples will also be taken at study entry, weeks 2, 4, 8, 12, 16, 20, 24, 32, 40, and 48. Additionally, blood samples will be drawn twice, at least 30 minutes apart, at weeks 2 and 24 for maraviroc (UK-427,857) pharmacokinetic analysis. As part of this clinical study a blood sample will also be taken for non-anonymized pharmacogenetic analysis. Patients will undergo a 12-lead electrocardiogram at study entry, weeks 24 and 48.


Condition Intervention Phase
HIV Infections
Drug: Optimized Background Therapy (OBT)
Drug: maraviroc (UK-427,857)
Phase 2
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Investigator)
Primary Purpose: Treatment
Official Title: A Multicenter, Randomized, Double-Blind Placebo-Controlled Trial of a Novel CCR5 Antagonist, UK-427,857, in Combination With Optimized Background Therapy Versus Optimized Background Therapy Alone for the Treatment of Antiretroviral-Experienced, Non CCR5-Tropic HIV-1 Infected Subjects

Resource links provided by NLM:


Further study details as provided by ViiV Healthcare:

Primary Outcome Measures:
  • Change From Baseline in Human Immunodeficiency Virus (HIV-1) Viral Load (Ribonucleic Acid [RNA]) [ Time Frame: Baseline to Week 24 and Week 48 ] [ Designated as safety issue: No ]
    Change from baseline in log 10-transformed plasma viral load (HIV-1 RNA) levels (log 10 copies per milliliter [log10 copies/mL]). Baseline value calculated as average of pre-dose measurements collected at screening, randomization, and baseline visits.


Secondary Outcome Measures:
  • Number of Subjects With HIV-1 RNA Levels < 400 Copies/mL [ Time Frame: Week 24, Week 48 ] [ Designated as safety issue: No ]
  • Number of Subjects With HIV-1 RNA Levels < 400 Copies/mL or at Least 0.5 Log 10-transformed Decrease From Baseline in HIV-1 RNA Levels [ Time Frame: Baseline, Week 24, Week 48 ] [ Designated as safety issue: No ]
    Number of subjects with HIV-1 RNA levels < 400 copies/mL or at least 0.5 log 10-transformed decrease from baseline in HIV-1 RNA levels. Baseline value calculated as average of pre-dose measurements collected at screening, randomization, and baseline visits.

  • Number of Subjects With HIV-1 RNA Levels < 400 Copies/mL or at Least 1.0 Log 10-transformed Decrease From Baseline in HIV-1 RNA Levels [ Time Frame: Baseline, Week 24, Week 48 ] [ Designated as safety issue: No ]
    Number of subjects with HIV-1 RNA levels < 400 copies/mL or at least 1.0 log 10-transformed decrease from baseline in HIV-1 RNA levels. Baseline value calculated as average of pre-dose measurements collected at screening, randomization, and baseline visits.

  • Number of Subjects With HIV-1 RNA Levels < 50 Copies/mL [ Time Frame: Baseline, Week 24, Week 48 ] [ Designated as safety issue: No ]
  • Change From Baseline in CD4 Cell Count [ Time Frame: Baseline to Week 24 and Week 48 ] [ Designated as safety issue: No ]
    Change from baseline in CD4 cell count (measured as cells per microliter [cells/µL]). Baseline value calculated as the average of pre-dose measurements collected at screening, randomization, and baseline visits.

  • Change From Baseline in CD8 Cell Count [ Time Frame: Baseline to Week 24 and Week 48 ] [ Designated as safety issue: No ]
    Change from baseline in CD8 cell count (measured as cells/µL). Baseline value calculated as the average of pre-dose measurements collected at screening, randomization, and baseline visits.

  • Time (50% Quartile Point Estimate) to Virologic Failure [ Time Frame: Day 1 through Week 24 and through Week 48 ] [ Designated as safety issue: No ]
    Time to virologic failure based on observed HIV-1 RNA levels and failure events (death; permanent discontinuation of test drug [perm DC]; lost to follow-up [LTFU]; new anti-retroviral drug added (except background drug change to drug of same class); or on open label for early non-response or rebound). Failure: at Time 0 if level not <400 copies/mL (2 consecutive visits) before event(s) or last available visit; at time of earliest event if level <400 copies/mL (on 2 consecutive visits); failure if level ≥400 copies/mL (2 consecutive visits) or 1 visit ≥400 copies/mL followed by perm DC or LTFU.

  • Change From Baseline in Time Averaged Difference (TAD) in log10 HIV-1 RNA [ Time Frame: Baseline to Week 24 and Week 48 ] [ Designated as safety issue: No ]
    Change from baseline of TAD in log10 HIV-1 RNA viral load calculated as [AUC of HIV-1 RNA viral load (log10 copies/mL) / time period] - Baseline HIV-1 RNA viral load (log10 copies/mL). Baseline value calculated as the average of pre-dose measurements collected at screening, randomization, and baseline visits.

  • Number of Subjects Per Genotype and Phenotype at Baseline and at Time of Failure [ Time Frame: Baseline through Week 48 ] [ Designated as safety issue: No ]
    Number of subjects per genotype and phenotype (tests for presence of non CCR5-tropic HIV-1 and for resistance to reverse transcriptase, protease, and fusion inhibitors) at baseline and at time of failure through Week 48 visit. Sensitivity to drug categorized as 0-1, 2-4, >4; scores defined as 0=resistance, 1=sensitive or susceptible with higher number indicating greater sensitivity or susceptibility.

  • Number of Subjects Per Tropism Status at Screening and at the Time of Treatment Failure (Analysis at Week 24) [ Time Frame: Screening through Week 24 ] [ Designated as safety issue: No ]
    Number of subjects per Tropism status (CCR5 [R5], CXCR4 [X4], Dual Mixed [DM], or Non-reportable/Non-phenotypable [NR/NP]) at Screening (Scr) and at time of treatment failure (Tx fail). Treatment failure defined as insufficient clinical response. HIV-1 RNA viral load <500 copies/ml categorized as below lower limit of quantification (BLQ). Tropism may have been assessed at either the Screening or Baseline visit. The assessment for time of treatment failure is defined as the last on-treatment assessment.

  • Number of Subjects Per Tropism Status at Screening and Time of Treatment Failure (Analysis at Week 48) [ Time Frame: Screening through Week 48 ] [ Designated as safety issue: No ]
    Number of subjects per Tropism status (CCR5 [R5], CXCR4 [X4], Dual Mixed [DM], or Non-reportable/Non-phenotypable [NR/NP]) at Screening (Scr) and at time of treatment failure (Tx fail). Treatment failure defined as insufficient clinical response. HIV-1 RNA viral load <500 copies/ml categorized as below lower limit of quantification (BLQ). Tropism may have been assessed at either the Screening or Baseline visit. The assessment for time of treatment failure is defined as the last on-treatment assessment.

  • Number of Subjects With Treatment Failure at Week 24 by Overall Susceptibility Score (OSS) at Screening [ Time Frame: Screening, Week 24 ] [ Designated as safety issue: No ]
    Number of subjects for association between screening resistance and virologic response as determined by treatment failure and OSS at screening. OSS categorized as 0-1, 2-4, >4 (maximum value of 6) and calculated as the sum of the net assessment of in vitro phenotypic and genotypic susceptibility using a binary scoring system (0= reduced susceptibility, 1=susceptible) for each antiretroviral agent in OBT. Higher scores indicate greater susceptibility.

  • Number of Subjects With Treatment Failure at Week 48 by Overall Susceptibility Score (OSS) at Screening [ Time Frame: Screening, Week48 ] [ Designated as safety issue: No ]
    Number of subjects for association between screening resistance and virologic response as determined by treatment failure and OSS at screening. OSS categorized as 0, 1, 2, or ≥3 (maximum value of 6) and calculated as the sum of the net assessment of in vitro phenotypic and genotypic susceptibility using a binary scoring system (0= reduced susceptibility, 1=susceptible) for each antiretroviral agent in OBT. Higher scores indicate greater susceptibility.

  • Number of Subjects With Acquired Immunodeficiency Syndrome (AIDS)-Defining Opportunistic Illnesses (Analysis at Week 24) [ Time Frame: Baseline through Week 24 ] [ Designated as safety issue: No ]
    Number of subjects with AIDS-defining opportunistic illnesses based on investigator classification guided by a predefined list of clinical Category C Adverse Events per Center for Disease Control (CDC) HIV Classification System. Includes events occurring up to 7 days after last dose of study drug.

  • Number of Subjects With Acquired Immunodeficiency Syndrome (AIDS)-Defining Opportunistic Illnesses (Analysis at Week 48) [ Time Frame: Baseline through Week 48 ] [ Designated as safety issue: No ]
    Number of subjects with AIDS-defining opportunistic illnesses based on investigator classification guided by a predefined list of clinical Category C Adverse Events per CDC HIV Classification System. Includes events occurring up to 7 days after last dose of study drug.


Enrollment: 190
Study Start Date: November 2004
Study Completion Date: April 2009
Primary Completion Date: December 2005 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: 1 Drug: Optimized Background Therapy (OBT)
OBT (3-6 drugs based on treatment history and resistance testing)
Drug: maraviroc (UK-427,857)
maraviroc (UK-427,857) 150 mg taken once daily
Other Name: Selzentry, Celsentri
Experimental: 2 Drug: Optimized Background Therapy (OBT)
OBT (3-6 drugs based on treatment history and resistance testing)
Drug: maraviroc (UK-427,857)
maraviroc (UK-427,857) 150 mg taken twice daily
Other Name: Selzentry, Celsentri
Experimental: 3 Drug: Optimized Background Therapy (OBT)
OBT (3-6 drugs based on treatment history and resistance testing)

Detailed Description:

(i) Subjects remained on their assigned therapy for 48 weeks, unless the subject was discontinued early for protocol-defined treatment failure or other reasons such as adverse event, loss to follow-up, withdrawal of consent, or death.

(ii) If a subject met the criteria for treatment failure or discontinued for another reason (eg, pregnancy, adverse event) and required an alternative regimen, the subject was followed until the Week 48 visit according to protocol guidelines. The new regimen, selected by the Investigator based on the results of resistance testing at the time of failure, had to be recorded in the CRF.

(iii) Open-label maraviroc (UK-427,857) was provided by the sponsor, until it was commercially available, to subjects who completed 48 weeks of therapy and for whom it was medically appropriate to continue therapy with maraviroc (UK-427,857).

  Eligibility

Ages Eligible for Study:   16 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Men or women at least 16 years of age (or minimum age as determined by local regulatory authorities)
  • HIV-1 RNA viral load of greater than or equal to 5,000 copies/mL
  • Stable pre-study antiretroviral regimen, or on no antiretroviral agents, for at least 4 weeks
  • Documented genotypic or phenotypic resistance to two of the four antiretroviral drug classes, OR, Antiretroviral-class experience greater than or equal to 3 months (sequential or cumulative) with at least three of the following: One nucleoside or nucleotide reverse transcriptase inhibitor (excluding low-dose ritonavir) and/or enfuvirtide
  • Be willing to remain on randomized treatment without any changes or additions to the OBT regimen, except for toxicity management or upon meeting criteria for treatment failure
  • A negative urine pregnancy test at the baseline visit for Women of Child Bearing Potential (WOCBP)
  • Effective barrier contraception for WOCBP and males

Exclusion Criteria:

  • Patients requiring treatment with more than 6 antiretroviral agents (excluding low-dose ritonavir)
  • Prior treatment with maraviroc (UK-427,857) or another experimental HIV entry inhibitor for more than 14 days
  • Suspected or documented active, untreated HIV-1 related opportunistic infection (OI) or other condition requiring acute therapy
  • Treatment for an active opportunistic infection, or unexplained temperature >38.5 degrees Celsius for 7 consecutive days
  • Active alcohol or substance abuse sufficient, in the Investigator's judgment, to prevent adherence to study medication and/or follow up
  • Lactating women, or planned pregnancy during the trial period
  • Significant renal insufficiency
  • Previous therapy with a potentially myelosuppressive, neurotoxic, hepatotoxic and/or cytotoxic agent within 30 days prior to randomization or the expected need for such therapy during the study period
  • Documented or suspected acute hepatitis or pancreatitis within 30 days prior to randomization
  • Significantly elevated liver enzymes or cirrhosis
  • Significant neutropenia, anemia or thrombocytopenia
  • Malabsorption or an inability to tolerate oral medications
  • Symptomatic postural hypotension or severe cardiovascular or cerebrovascular disease
  • Certain medications
  • Malignancy requiring parenteral chemotherapy that must be continued for the duration of the trial
  • R5 virus phenotype only
  • No option to use at least one non-nucleoside reverse transcriptase inhibitor or protease inhibitor, or enfuvirtide, based on resistance testing
  • Any other clinical condition that, in the Investigator's judgment, would potentially compromise study compliance or the ability to evaluate safety/efficacy
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00098748

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Locations
United States, Alabama
Pfizer Investigational Site
Birmingham, Alabama, United States, 35294
United States, Arizona
Pfizer Investigational Site
Phoenix, Arizona, United States, 85006
United States, California
Pfizer Investigational Site
Beverly Hills, California, United States, 90211
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Fountain Valley, California, United States, 92708
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Hayward, California, United States, 94545
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Los Angeles, California, United States, 90069
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Los Angeles, California, United States, 90028
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Los Angeles, California, United States, 90027
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Newport Beach, California, United States, 92663
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Oakland, California, United States, 94602
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San Francisco, California, United States, 94102
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San Francisco, California, United States, 94115-1931
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San Francisco, California, United States, 94118
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Union City, California, United States, 94587
United States, District of Columbia
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Washington, District of Columbia, United States, 20009
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Washington, District of Columbia, United States, 20036
United States, Florida
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Miami, Florida, United States, 33133
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North Miami Beach, Florida, United States, 33169
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Orlando, Florida, United States, 32806
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Orlando, Florida, United States, 32803
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Sarasota, Florida, United States, 34243
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Tampa, Florida, United States, 33614
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Vero Beach, Florida, United States, 32960
United States, Georgia
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Atlanta, Georgia, United States, 30308
United States, Massachusetts
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Springfield, Massachusetts, United States, 01107
United States, New Mexico
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Santa Fe, New Mexico, United States, 87505
United States, New York
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Albany, New York, United States, 12208
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Bronx, New York, United States, 10467
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Bronx, New York, United States, 10461
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Brooklyn, New York, United States, 11203
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Manhasset, New York, United States, 11030
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New York, New York, United States, 10018
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Stony Brook, New York, United States, 11794
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Stony Brook, New York, United States, 11794-7310
United States, North Carolina
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Huntersville, North Carolina, United States, 28078
United States, Pennsylvania
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Philadelphia, Pennsylvania, United States, 19106
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Philadelphia, Pennsylvania, United States, 19130
United States, South Carolina
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Columbia, South Carolina, United States, 29206
United States, Texas
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Dallas, Texas, United States, 75246
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Dallas, Texas, United States, 75204
United States, Virginia
Pfizer Investigational Site
Annandale, Virginia, United States, 22003
United States, Washington
Pfizer Investigational Site
Puyallup, Washington, United States, 98372
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Tacoma, Washington, United States, 98405
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Vancouver, Washington, United States, 98664
Australia, New South Wales
Pfizer Investigational Site
Darlinghurst, New South Wales, Australia, 2010
Pfizer Investigational Site
Surry Hills, New South Wales, Australia, 2010
Australia, Queensland
Pfizer Investigational Site
Herston, Queensland, Australia, 4029
Australia, Victoria
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Carlton, Victoria, Australia, 3053
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Melbourne, Victoria, Australia, 3004
Belgium
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Brussels, Belgium, 1000
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Brussels, Belgium, 1070
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Brussels, Belgium, 1200
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Liege, Belgium, 4000
Canada, Manitoba
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Winnipeg, Manitoba, Canada, R3A 1R9
Canada, Ontario
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Toronto, Ontario, Canada, M5B 1W8
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Toronto, Ontario, Canada, M5G 2N2
Canada, Quebec
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Montreal, Quebec, Canada, H2L 5B1
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Montreal, Quebec, Canada, H2L 4P9
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Montreal, Quebec, Canada, H3G 1A4
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Montreal, Quebec, Canada, H2X 2P4
Germany
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Berlin, Germany, 12157
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Hamburg, Germany, 20146
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Hamburg, Germany, 20099
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Hamburg, Germany, 20246
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Koeln, Germany, 50924
Netherlands
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Utrecht, Netherlands, 3584 CX
Spain
Pfizer Investigational Site
Elche, Alicante, Spain, 03202
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Badalona, Barcelona, Spain, 08916
Pfizer Investigational Site
Barcelona, Spain, 08025
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Cordoba, Spain, 14004
Pfizer Investigational Site
Madrid, Spain, 28006
Pfizer Investigational Site
Madrid, Spain, 28046
Switzerland
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Zürich, Switzerland, 8091
United Kingdom
Pfizer Investigational Site
Brighton, United Kingdom, BN2 1ES
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Edinburgh, United Kingdom, EH4 2XU
Pfizer Investigational Site
London, United Kingdom, SE5 9RS
Pfizer Investigational Site
London, United Kingdom, SW10 9TH
Sponsors and Collaborators
ViiV Healthcare
Pfizer
Investigators
Study Director: Pfizer CT.gov Call Center Pfizer
  More Information

Additional Information:
No publications provided by ViiV Healthcare

Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Director, Clinical Trial Disclosure Group, Pfizer, Inc.
ClinicalTrials.gov Identifier: NCT00098748     History of Changes
Other Study ID Numbers: A4001029
Study First Received: December 7, 2004
Results First Received: March 25, 2010
Last Updated: November 19, 2010
Health Authority: United States: Food and Drug Administration

Additional relevant MeSH terms:
HIV Infections
Acquired Immunodeficiency Syndrome
Lentivirus Infections
Retroviridae Infections
RNA Virus Infections
Virus Diseases
Sexually Transmitted Diseases, Viral
Sexually Transmitted Diseases
Immunologic Deficiency Syndromes
Immune System Diseases
Slow Virus Diseases

ClinicalTrials.gov processed this record on August 21, 2014