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Atripla to Raltegravir Switch Study (SSAT036)

This study is currently recruiting participants.
Verified June 2012 by St Stephens Aids Trust
Sponsor:
Information provided by (Responsible Party):
St Stephens Aids Trust
ClinicalTrials.gov Identifier:
NCT01195467
First received: September 3, 2010
Last updated: June 8, 2012
Last verified: June 2012
History of Changes
  Purpose

The purpose of the study is to investigate the benefits of switching away from efavirenz (part of the combination pill, Atripla®) in patients with central nervous system side effects (such as insomnia {difficulty with sleeping}, bad dreams etc). The investigators will investigate the effect of switching to Truvada (a combination pill of tenofovir and emtricitabine, the other two components of Atripla) plus raltegravir.

Raltegravir is a licensed drug for HIV treatment which showed side effects were fewer in number when compared to efavirenz in 2 other clinical studies, where patients were starting HIV treatment for the first time.

This study will also investigate the safety (in terms of other side effects and the routine blood tests which the investigators ordinarily use to monitor your treatment) and monitor effectiveness, your viral load and CD4 counts, when you switch treatment from Atripla® to Truvada/raltegravir.


Condition Intervention Phase
HIV Infection
 Drug: Truvada/Raltegravir
 Phase 3

Study Type: Interventional
Study Design: Endpoint Classification: Pharmacokinetics Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Phase III, Open-label, Single Centre, Single-arm, Pilot Study to Assess the Feasibility of Switching, Individuals Receiving Efavirenz With Continuing Central Nervous System (CNS) Toxicity, to Raltegravir

Resource links provided by NLM:

MedlinePlus related topics: HIV/AIDS
U.S. FDA Resources

Further study details as provided by St Stephens Aids Trust:

Primary Outcome Measures:
  • The rate of neuropsychiatric and central nervous system (CNS) toxicity of raltegravir therapy [ Time Frame: 4 weeks ] [ Designated as safety issue: No ]

    To assess the rate of neuropsychiatric and central nervous system (CNS) toxicity as measured after 4 weeks of raltegravir therapy as measured by :

    • Sleep questionnaire
    • CNS toxicity (as determined by questionnaire based on efavirenz SPC and graded based on the ACTG adverse event scale)


Secondary Outcome Measures:
  • The rate of neuropsychiatric and central nervous system (CNS) toxicity of raltegravir therapy [ Time Frame: baseline to week 12 ] [ Designated as safety issue: No ]

    The rate of neuropsychiatric and central nervous system (CNS) toxicity as measured after 12 weeks of raltegravir therapy as measured by :

    • Sleep questionnaire
    • CNS toxicity (as determined by questionnaire based on efavirenz SPC and graded based on the ACTG adverse event scale)

  • Change from baseline to week 12 in CD4+ count after 12 weeks of raltegravir [ Time Frame: baseline to week 12 ] [ Designated as safety issue: No ]
    Change from baseline to week 12 in CD4+ count after 12 weeks of raltegravir

  • Proportion of patients with viral load < 50 copies/mL and <400 copies/ml at weeks 4 and 12 after switching to raltegravir [ Time Frame: week 4 to week 12 ] [ Designated as safety issue: No ]
    To assess the proportion of patients with viral load < 50 copies/mL and <400 copies/ml at weeks 4 and 12 after switching to raltegravir

  • Change in fasting lipids (total cholesterol and subfractions and triglycerides) after 4 and 12 weeks of raltegravir [ Time Frame: week 4 to week 12 ] [ Designated as safety issue: No ]
    To assess the change in fasting lipids (total cholesterol and subfractions and triglycerides) after 4 and 12 weeks of raltegravir

  • Proportion of patients with grade 2-4 laboratory parameters (excluding lipids) after 12 weeks of raltegravir compared with baseline [ Time Frame: baseline to week 12 ] [ Designated as safety issue: No ]
    To assess the proportion of patients with grade 2-4 laboratory parameters (excluding lipids) after 12 weeks of raltegravir compared with baseline

  • Proportion of patients with grade 2-4 non-CNS adverse events after 12 weeks of raltegravir compared with baseline [ Time Frame: baseline to week 12 ] [ Designated as safety issue: No ]
    To assess the proportion of patients with grade 2-4 non-CNS adverse events after 12 weeks of raltegravir compared with baseline

  • Change from baseline in adherence from baseline after 12 weeks of raltegravir as measured by the adherence questionnaire: Medication Adherence Self-Report Inventory (M-MASRI) [ Time Frame: baseline to week 12 ] [ Designated as safety issue: No ]
    To assess the change from baseline in adherence from baseline after 12 weeks of raltegravir as measured by the adherence questionnaire: Medication Adherence Self-Report Inventory (M-MASRI)

  • Change from baseline of CNS toxicity as measured by Hospital Anxiety and Depression (HADS) score (baseline vs week 12) [ Time Frame: baseline to week 12 ] [ Designated as safety issue: No ]
    To assess the change from baseline of CNS toxicity as measured by Hospital Anxiety and Depression (HADS) score (baseline vs week 12)


Estimated Enrollment: 40
Study Start Date: October 2010
Estimated Study Completion Date: September 2012
Estimated Primary Completion Date: September 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: All Subjects
All Subjects will receive the same intervention
 Drug: Truvada/Raltegravir
All subjects currently on Atripla® will switch to Truvada/Raltegravir
Other Names:
  • Truvada® = tenofovir + emtricitabine
  • Atripla® = tenofovir + emtricitabine + efavirenz
  • Raltegravir = isentress

Detailed Description:

The majority of individuals who commence treatment for HIV in the UK start with a regimen that includes EFV in combination with other antiretrovirals. These regimens are convenient (once daily dosing) and highly efficacious. However EFV has several potential drawbacks including continued CNS toxicity, the potential for teratogenesis and a low barrier to the development of virological resistance.

Clinically controlled trials frequently reported undesirable nervous system side effects in patients receiving 600 mg EFV with other antiretroviral agents, including dizziness, insomnia, somnolence, impaired concentration and abnormal dreaming. CNS symptoms of moderate to severe intensity were experienced by 19.4% of patients compared to 9.0% of patients receiving control regimens. These symptoms were severe in 2.0% of patients receiving EFV 600 mg daily and in 1.3% of patients receiving control regimens. In clinical studies 2.1% of patients treated with 600 mg of EFV discontinued therapy because of nervous system symptoms

The majority of individuals who commence treatment for HIV in the UK start with a regimen that includes EFV in combination with other antiretrovirals. These regimens are convenient (once daily dosing) and highly efficacious. However EFV has several potential drawbacks including continued CNS toxicity, the potential for teratogenesis and a low barrier to the development of virological resistance.

Clinically controlled trials frequently reported undesirable nervous system side effects in patients receiving 600 mg EFV with other antiretroviral agents, including dizziness, insomnia, somnolence, impaired concentration and abnormal dreaming. CNS symptoms of moderate to severe intensity were experienced by 19.4% of patients compared to 9.0% of patients receiving control regimens. These symptoms were severe in 2.0% of patients receiving EFV 600 mg daily and in 1.3% of patients receiving control regimens. In clinical studies 2.1% of patients treated with 600 mg of EFV discontinued therapy because of nervous system symptoms.

  Eligibility

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

Inclusion Criteria:

  1. is male or female aged 18 years or above
  2. has a documented HIV-1 infection
  3. has signed the Informed Consent Form voluntarily
  4. is willing to comply with the protocol requirements
  5. has an HIV-plasma viral load at screening <50 copies/mL
  6. has a CD4 cell count at Screening >50 cells/mm3
  7. has been on a stable ART, with at least 3 licensed agents, one of which being EFV, for at least 12 weeks at Screening, and has been on Atripla for at least 4 weeks at screening; the subject must be willing to stay on treatment until Baseline
  8. estimated glomerular filtration rate (by MDRD or CG methods) >50 ml/min.
  9. has symptomatic toxicity associated with EFV after at least 12 weeks of therapy
  10. if female and of childbearing potential, she is using effective birth control methods (as agreed by the investigator) and is willing to continue practising these birth control methods during the trial and for at least 30 days after the end of the trial (or after last intake of investigational ARVs); Note: Women who are postmenopausal for least 2 years, women with total hysterectomy, and women who have a tubal ligation are considered of non-childbearing potential
  11. if a heterosexually active male, he is using effective birth control methods and is willing to continue practising these birth control methods during the trial and until follow-up visit

Exclusion Criteria:

  1. is infected with HIV-2
  2. is using any concomitant therapy disallowed as per SPC for the study drugs (section 5.2)

  3. has a currently active AIDS defining illness (Category C conditions according to the CDC Classification System for HIV Infection 1993) with the following exceptions (must be discussed with the sponsor prior to enrolment):

    • Stable cutaneous Kaposi's Sarcoma (no pulmonary or gastrointestinal involvement other than oral lesions) unlikely to require systemic therapy during the trial period
    • CD4 count less than 200 cells/mm3 Note: Primary and secondary prophylaxis for an AIDS defining illness is allowed
  4. has acute viral hepatitis including, but not limited to, A, B, or C
  5. has chronic hepatitis B and/or C with AST and/or ALT >5 x ULN Note: Subjects co-infected with chronic HBV or HCV can enter the trial if clinically stable and not expected to require treatment during the trial period.
  6. has received any investigational drug within 30 days prior to the trial drug administration
  7. Prior exposure to raltegravir or investigational integrase inhibitors
  8. Any tenofovir or emtricitabine associated resistance mutations
  9. No baseline resistance test available
  10. Clinically significant allergy or hypersensitivity to any trial medication excipients
  11. If female, she is pregnant or breastfeeding
  12. screening blood results with any grade 3 / 4 toxicity according to Division of AIDS (DAIDS) grading scale, except: asymptomatic grade 3 glucose, amylase or lipid elevation or asymptomatic grade 4 triglyceride elevation (re-test allowed).
  13. Clinical or laboratory evidence of significantly decreased hepatic function or decompensation: INR > 1.5 or albumin < 30g/L or bilirubin > 2.5 x ULN
  14. Resolution of their CNS toxicity between Screening and Baseline visits
  15. Any condition (including drug/alcohol abuse) or laboratory results which, in the investigator's opinion, interfere with assessments or completion of the trial.
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT01195467

Contacts
Contact: Mark Nelson, Dr 02088465610 mark.nelson@chelwest.nhs.uk
Contact: Laura Waters, Dr 02088466503 laura.waters@chelwest.nhs.uk

Locations
United Kingdom
St Stephen's Centre Recruiting
London, United Kingdom, SW10 9NH
Contact: Chris Higgs     0208 846 6135     chris.higgs@chelwest.nhs.uk    
Contact: Carl Fletcher     0208 846 6323     carl.fletcher@chelwest.nhs.uk    
Sub-Investigator: Laura Waters, Dr            
Sponsors and Collaborators
St Stephens Aids Trust
Investigators
Principal Investigator: Mark Nelson, Dr St Stephen's AIDS Trust
  More Information

No publications provided

Responsible Party: St Stephens Aids Trust
ClinicalTrials.gov Identifier: NCT01195467     History of Changes
Other Study ID Numbers: SSAT 036
Study First Received: September 3, 2010
Last Updated: June 8, 2012
Health Authority: United Kingdom: Medicines and Healthcare Products Regulatory Agency

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
Tenofovir
Efavirenz
 Efavirenz, emtricitabine, tenofovir disoproxil fumarate drug combination
Emtricitabine
Reverse Transcriptase Inhibitors
Nucleic Acid Synthesis Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Anti-Retroviral Agents
Antiviral Agents
Anti-Infective Agents
Therapeutic Uses
Anti-HIV Agents

ClinicalTrials.gov processed this record on May 23, 2013