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Evaluating Once Daily Etravirine in Treatment-Naive Adults With HIV Infection
This study is currently recruiting participants.
Verified by The University of North Carolina, Chapel Hill, December 2009
First Received: August 14, 2009   Last Updated: December 4, 2009   History of Changes
Sponsor: The University of North Carolina, Chapel Hill
Collaborator: Tibotec Therapeutics, a Division of Ortho Biotech Products, L.P., USA
Information provided by: The University of North Carolina, Chapel Hill
ClinicalTrials.gov Identifier: NCT00959894
  Purpose

The main study is a single arm, open-label, prospective study to assess antiretroviral activity and tolerability of etravirine (TMC-125) 400 mg once daily, given with fixed-dose tenofovir/emtricitabine, in treatment-naïve HIV-1-infected men and women. There are also a genital secretions pharmacokinetic (PK) sub-study and a metabolic sub-study. The purpose of the genital secretions PK sub-study is to gain information about drug levels and HIV-1 RNA in genital secretions when subjects are taking etravirine. The purpose of the metabolic sub-study is to learn about the effects of etravirine on body composition, as well as lipid and glucose levels.


Condition Intervention Phase
HIV Infections
Drug: Etravirine (Intelence)
Phase II

Study Type: Interventional
Study Design: Treatment, Open Label, Single Group Assignment, Safety/Efficacy Study
Official Title: Antiretroviral Activity and Tolerability of Once Daily Etravirine in Treatment-Naïve Adults With HIV-1 Infection

Resource links provided by NLM:


Further study details as provided by The University of North Carolina, Chapel Hill:

Primary Outcome Measures:
  • To estimate the antiretroviral activity of etravirine 400 mg given once daily, with fixed-dose Truvada once daily, among treatment-naïve HIV-1 infected adults as measured by the proportion of participants with HIV RNA < 50 copies/mL at Week 24. [ Time Frame: August 2010 ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • To assess the proportion of participants with HIV RNA <50 copies/mL at Week 48 and Week 96 of treatment with etravirine and fixed-dose tenofovir/emtricitabine. [ Time Frame: January 2012 ] [ Designated as safety issue: No ]
  • To assess the proportion of participants with HIV RNA <200 copies/mL at Weeks 24, 48, and 96 of treatment with etravirine and fixed-dose tenofovir/emtricitabine. [ Time Frame: January 2012 ] [ Designated as safety issue: No ]
  • To assess change in CD4+ cell count from baseline to Weeks 24, 48 and 96 of treatment with etravirine and fixed-dose tenofovir/emtricitabine. [ Time Frame: January 2012 ] [ Designated as safety issue: No ]
  • To assess resistance mutations in the subset of patients with virologic failure while on etravirine and fixed-dose tenofovir/emtricitabine who have HIV RNA >500 copies/mL and genotype resistance results. [ Time Frame: January 2012 ] [ Designated as safety issue: No ]
  • To assess population pharmacokinetics of etravirine 400 mg once daily, in combination with fixed-dose emtricitabine-tenofovir among treatment-naïve HIV-1 infected adults. [ Time Frame: January 2012 ] [ Designated as safety issue: No ]
  • To assess pharmacokinetics of etravirine in genital secretions of up to 10 men and up to 10 women at Week 4 of treatment with etravirine and fixed-dose tenofovir/emtricitabine. [ Time Frame: August 2010 ] [ Designated as safety issue: No ]
  • To assess tolerability of etravirine in HIV-1 infected adults initiating antiretroviral therapy. [ Time Frame: January 2012 ] [ Designated as safety issue: Yes ]
  • To assess change in the lipid profile and glucose metabolism, in a subgroup of up to 40 participants, from baseline to Weeks 24, 48, and 96 of treatment with etravirine and fixed-dose tenofovir/emtricitabine. [ Time Frame: January 2012 ] [ Designated as safety issue: No ]
  • To assess change in limb and trunk fat distribution as measured by DEXA scan, in the same subgroup of up to 40 participants (as in Aim 8), from baseline to Weeks 24 and 96 of treatment with etravirine and fixed-dose tenofovir/emtricitabine. [ Time Frame: January 2012 ] [ Designated as safety issue: No ]

Estimated Enrollment: 80
Study Start Date: September 2009
Estimated Study Completion Date: June 2013
Estimated Primary Completion Date: January 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Etravirine 400 mg once daily: Experimental
Etravirine 400 mg once daily with fixed dose tenofovir/emtricitabine (Truvada) one tablet once daily
Drug: Etravirine (Intelence)
Etravirine 400 mg (four 100 mg tablets) taken orally once a day with one pill of Truvada (200 mg of emtricitabine and 300 mg of tenofovir) taken orally once a day

Detailed Description:

Participants: There will be approximately 80 HIV-1-infected men and women aged 18 years or older who have taken less than or equal to 10 days of prior antiretroviral therapy and have never taken etravirine, dapivirine (TMC120), or rilpivirine (TMC 278) in the main study. There will be approximately 40 subjects who enroll in the main study that will be in the metabolic sub-study and approximately 20 subjects (10 pre-menopausal women and 10 men) who enroll in the main study that will be in the genital secretions PK sub-study.

Procedures (methods): For the main study subjects will take etravirine 400 mg once daily orally with fixed-dose tenofovir/emtricitabine (Truvada) one tablet once daily. For the genital secretions PK sub-study, genital secretion samples will be self-collected throughout the study except for the week 4 study visit where women will have the cervicovaginal sample at time 0 and at 24 hours collected by study staff. For the metabolic sub-study, waist measurements and DEXA scans will be performed at entry, week 24, and week 96, and 2-3 teaspoons of blood to check lipids, insulin, and glucose will be taken at entry and weeks 12, 24, 48, and 96.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • HIV-1 infection as documented by any licensed ELISA test and confirmed by Western Blot or other confirmatory test at any time prior to study entry. Acceptable alternative confirmatory tests are plasma HIV-1 RNA, HIV-1 culture, HIV-1 antigen, or a second antibody test by a method other than ELISA.
  • Age 18 years or older.
  • Able to provide informed consent.
  • In the opinion of the investigator, able to comply with study medication and procedures.
  • Plasma HIV-1 RNA ≥ 1000 copies/mL as measured by any FDA-approved test for quantifying HIV-1 RNA within 90 days prior to study entry.
  • Less than or equal to 10 days of cumulative exposure to antiretroviral therapy.
  • For all women of reproductive potential, a negative urine or serum β-HCG pregnancy test performed within 48 hours prior to study entry.

    • All study volunteers, both male and female, must agree not to participate in a conception process (i.e., active attempt to become pregnant or to impregnate, sperm donation, in vitro fertilization) while receiving study medications and for 6 weeks after stopping study medications.
    • If participating in sexual activity that could lead to conception, study volunteers must agree to use at least one method of reliable contraception which must be a barrier method (i.e., a condom without spermicide, a diaphragm, or cervical cap) throughout the study and for 6 weeks thereafter.

NOTE: Acceptable documentation of lack of reproductive potential for a woman is self-reported history of being postmenopausal for at least 24 months, or having had surgical sterilization (hysterectomy, or bilateral oophorectomy, or bilateral tubal ligation) or of male partner's azoospermia. Acceptable documentation for a man is self-reported history of azoospermia.

  • Hemoglobin ≥ 7.5 g/dL within 45 days prior to study entry.
  • Absolute neutrophil count ≥ 500/mm³ within 45 days prior to study entry.
  • Platelets ≥ 50,000/mm³ within 45 days prior to study entry.
  • Prothrombin time < 1.50 X upper limit of normal (ULN) within 45 days prior to study entry.
  • Aspartate aminotransferase (AST), alanine aminotransferase (ALT) ≤ 3X ULN or bilirubin ≤ 2.5 ULN within 45 days prior to study entry.
  • GFR ≥ 60 as calculated by MDRD within 45 days prior to study entry.

Exclusion Criteria:

  • Prior receipt of etravirine, dapivirine (TMC120), or rilpivirine (TMC 278).
  • Evidence of any of the resistance-associated mutations listed below at baseline on genotype testing performed at the study screening visit. Any pending resistance testing ordered prior to study entry must be available for review by the investigator prior to enrollment. Major resistance mutations include:

    1. Any of the following NNRTI mutations: V90I, A98G, L100I, K101E/H/P/Q, K103H/S/T, V106A/I/M, V108I, E138A/G/K/Q, V179D/E/F/G/I/T, Y181C/I/V, Y188C/H/L, V189I, G190A/C/E/Q/S, H221Y, P225H, F227C/L, M230I/L, P236L, K238N/T, K103N.
    2. Any of the following NRTI mutations: M184V/I, K70E/R, K65R, M41L, 69 insert, K70R, L210W, T215Y/F, K219Q/E.
  • Pregnancy
  • Breastfeeding
  • Any condition which, in the opinion of the investigator, would be likely to interfere with ability to take the study medications appropriately and comply with the study protocol.
  • Use of any systemic antineoplastic or immunomodulatory treatment, systemic corticosteroids, investigational vaccines, interleukins, interferons, growth factors, or intravenous immunoglobulin (IVIG) within 30 days prior to study entry.

NOTE: Routine standard of care, including hepatitis B, influenza, pneumococcus, and tetanus vaccines are permitted.

  • Current active illness requiring systemic treatment and/or hospitalization until the individual completes therapy or, in the opinion of the investigator, is clinically stable on therapy for at least 7 days prior to study entry.
  • Life expectancy of less than 6 months.
  • Acute viral hepatitis.
  • Known allergy/hypersensitivity to components of the study drugs or their formulations.
  • Use of any medications that are prohibited during the study period (see Section 8.1 of the protocol - Prohibited Medications).
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00959894

Contacts
Contact: Tracey Lee, FNP 919-843-8760 tracey_lee@med.unc.edu

Locations
United States, North Carolina
The University of North Carolina at Chapel Hill Recruiting
Chapel Hill, North Carolina, United States, 27599-7215
Contact: Tracey Lee, FNP     919-843-8760     tracey_lee@med.unc.edu    
Principal Investigator: Michelle Floris-Moore, MD, MS            
Sub-Investigator: Joseph Eron, MD            
Sub-Investigator: David Wohl, MD            
Sub-Investigator: Kristine Patterson, MD            
Sub-Investigator: Angela Kashuba, PharmD            
Sponsors and Collaborators
The University of North Carolina, Chapel Hill
Tibotec Therapeutics, a Division of Ortho Biotech Products, L.P., USA
Investigators
Principal Investigator: Michelle Floris-Moore, MD, MS The University of North Carolina, Chapel Hill
  More Information

Publications:
Gruzdev B, Rakhmanova A, Doubovskaya E, Yakovlev A, Peeters M, Rinehart A, de Dier K, Baede-Van Dijk P, Parys W, van 't Klooster G. A randomized, double-blind, placebo-controlled trial of TMC125 as 7-day monotherapy in antiretroviral naive, HIV-1 infected subjects. AIDS. 2003 Nov 21;17(17):2487-94.
TMC125-C223 Writing Group; Nadler JP, Berger DS, Blick G, Cimoch PJ, Cohen CJ, Greenberg RN, Hicks CB, Hoetelmans RM, Iveson KJ, Jayaweera DS, Mills AM, Peeters MP, Ruane PJ, Shalit P, Schrader SR, Smith SM, Steinhart CR, Thompson M, Vingerhoets JH, Voorspoels E, Ward D, Woodfall B. Efficacy and safety of etravirine (TMC125) in patients with highly resistant HIV-1: primary 24-week analysis. AIDS. 2007 Mar 30;21(6):F1-10.
Shikuma CM, Yang Y, Glesby MJ, Meyer WA 3rd, Tashima KT, Ribaudo HJ, Webb N, Bastow B, Kuritzkes DR, Gulick RM. Metabolic effects of protease inhibitor-sparing antiretroviral regimens given as initial treatment of HIV-1 Infection (AIDS Clinical Trials Group Study A5095). J Acquir Immune Defic Syndr. 2007 Apr 15;44(5):540-50.
Madruga JV, Cahn P, Grinsztejn B, Haubrich R, Lalezari J, Mills A, Pialoux G, Wilkin T, Peeters M, Vingerhoets J, de Smedt G, Leopold L, Trefiglio R, Woodfall B; DUET-1 study group. Efficacy and safety of TMC125 (etravirine) in treatment-experienced HIV-1-infected patients in DUET-1: 24-week results from a randomised, double-blind, placebo-controlled trial. Lancet. 2007 Jul 7;370(9581):29-38.
Lazzarin A, Campbell T, Clotet B, Johnson M, Katlama C, Moll A, Towner W, Trottier B, Peeters M, Vingerhoets J, de Smedt G, Baeten B, Beets G, Sinha R, Woodfall B; DUET-2 study group. Efficacy and safety of TMC125 (etravirine) in treatment-experienced HIV-1-infected patients in DUET-2: 24-week results from a randomised, double-blind, placebo-controlled trial. Lancet. 2007 Jul 7;370(9581):39-48.
Ghosn J, Chaix ML, Peytavin G, Rey E, Bresson JL, Goujard C, Katlama C, Viard JP, Tréluyer JM, Rouzioux C. Penetration of enfuvirtide, tenofovir, efavirenz, and protease inhibitors in the genital tract of HIV-1-infected men. AIDS. 2004 Sep 24;18(14):1958-61.
Reddy YS, Gotzkowsky SK, Eron JJ, Kim JY, Fiske WD, Fiscus SA, Petch L, Cohen MS, Kashuba AD. Pharmacokinetic and pharmacodynamic investigation of efavirenz in the semen and blood of human immunodeficiency virus type 1-infected men. J Infect Dis. 2002 Nov 1;186(9):1339-43. Epub 2002 Oct 7.
Taylor S, Reynolds H, Sabin CA, Drake SM, White DJ, Back DJ, Pillay D. Penetration of efavirenz into the male genital tract: drug concentrations and antiviral activity in semen and blood of HIV-1-infected men. AIDS. 2001 Oct 19;15(15):2051-3.
van Praag RM, Repping S, de Vries JW, Lange JM, Hoetelmans RM, Prins JM. Pharmacokinetic profiles of nevirapine and indinavir in various fractions of seminal plasma. Antimicrob Agents Chemother. 2001 Oct;45(10):2902-7. Erratum in: Antimicrob Agents Chemother 2002 Mar;46(3):941.
Scholler-Gyure M, Kakuda TN, De Smedt G, Woodfall B, Lachaert R, Beets G, Peeters M, Hoetelmans RM. Pharmacokinetics of TMC125 in once- and twice- daily regimens in HIV-1-negative volunteers. Program and Abstracts of the 47th Interscience Conference on Antimicrobial Agents and Chemotherapy, 2007 [Abstract A-1427], Chicago IL.
[No authors listed] 144-week data released on Gilead's study 934. AIDS Patient Care STDS. 2007 Aug;21(8):603-4. No abstract available.

Responsible Party: The University of North Carolina at Chapel Hill ( Michelle Floris-Moore, MD, MS )
Study ID Numbers: CID 0808, IND 104,941
Study First Received: August 14, 2009
Last Updated: December 4, 2009
ClinicalTrials.gov Identifier: NCT00959894     History of Changes
Health Authority: United States: Food and Drug Administration

Keywords provided by The University of North Carolina, Chapel Hill:
HIV
Infection
Treatment Naive
Adults
Once
Daily
Etravirine
HIV-1 Infection

Additional relevant MeSH terms:
Anti-Infective Agents
Communicable Diseases
RNA Virus Infections
Sexually Transmitted Diseases, Viral
Slow Virus Diseases
Immune System Diseases
Acquired Immunodeficiency Syndrome
Infection
Antiviral Agents
Pharmacologic Actions
Immunologic Deficiency Syndromes
Virus Diseases
Emtricitabine
HIV Infections
Therapeutic Uses
Sexually Transmitted Diseases
Lentivirus Infections
Retroviridae Infections

ClinicalTrials.gov processed this record on February 08, 2010