DRV/r + RPV QD: Efficacy and Toxicity Reduction
Clinical approach to HIV infection treatment is based on the use of highly active antiretroviral therapies (HAART) and recent national and international guidelines for guiding HIV therapy recommend the use of triple-combination therapy using antiretrovirals with 2 nucleos(t)ide inhibitors [N(n)RTI] as backbone plus a third drug to be chosen among a boosted protease inhibitor (PI/r), a nonnucleoside inhibitor (NNRTI) or an integrase inhibitor (II).
In spite of evident efficacy of HAART, as demonstrated by survival increasing, long term side effects, as for example the impact on renal function, remain principal problem.
In patient with risk factor for renal disease, a reduction of eGRF (estimated Glomerular Filtration Rate) between 90 and 60 mL/min/1,73 m2 could be already considered as a risk condition [1,2].
Efficacy of HAART, with increase of media survival and the parallel decrease of mortality, has underlined the necessity to reflect on long term HAART effects .
There are many evidences of HAART-related toxicity that, in spite of the necessity of a life-saving therapy, focus on the additional costs of this situation, in terms of health as well as in terms of economic costs.
Particular attention has been focused on the impact of some drugs on renal function, as tenofovir, especially on tubule, without forgetting the modification of lipid and bone metabolisms.
According to further studies which have evidenced the potential of some recently introduced molecules [4,5], the investigators had the need to realize a study to deepen the feasibility of a dual-therapy that permit to exclude NRTIs from the backbone, with the aim to prevent NRTIs-related long-term toxicity.
The investigators have designed a prospective randomized controlled trial, open-label, with a duration of 96 weeks, to compare the efficacy of a dual-therapy based on rilpivirine 25mg plus darunavir 800mg/ritonavir 100mg QD, in HIV-positive subjects with suppressed viremia from at least 3 months. In fact, there are a few data about association of these drugs, which it has been shown to be safe, well tolerated, and with a strong pharmacological synergy, without nucleos(t)idic backbone, while the necessity to minimize the costs toxicity-related is becoming increasingly compelling.
According to clinical experience and literature data, the investigators hope this study shows positive results in term of immune-virological efficacy, as well as in term of decrease of VACS index - a complex parameter which has the purpose to quantify general organic decay - and markers of lipid and bone metabolism, in group which receives dual-therapy versus the group with standard therapy.
|Human Immunodeficiency Virus||Drug: RPV + DRV/r Drug: continue the PI/r-containing HAART.||Phase 3|
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
|Official Title:||Strategic Study of Dual-therapy With Darunavir/Ritonavir and Rilpivirine QD Versus Triple-therapy in Patients With Suppressed Viral Load: Virological Efficacy and Evaluation of Non-HIV Related Morbidity.|
- HIV-RNA < 50 cp/mL [ Time Frame: Week 48 ]Responders: HIV+ subjects with HIV-RNA < 50 cp/mL at week 48 according to the intention-to-treat (ITT-TLOVR) approach.
- ACTG grade III and IV events. [ Time Frame: over 96 weeks. ]Safety will be assessed through the number of ACTG grade III and IV in the specified safety parameters.
|Study Start Date:||September 2014|
|Estimated Study Completion Date:||October 2017|
|Estimated Primary Completion Date:||September 2017 (Final data collection date for primary outcome measure)|
Experimental: RPV + DRV/r
switch to RPV + DRV/r
Drug: RPV + DRV/r
Switch to dual HAART
Active Comparator: continue the PI/r-containing HAART.
continue the PI/r-containing HAART
Drug: continue the PI/r-containing HAART.
Continue the on-going triple drug HAART.
Other Name: the drugs will depend on the successful regimen.
Pilot, phase III prospective, randomized, open-label, multicentric controlled study, which will offer a novel dual-therapy regimen including RPV 25mg + DRV 800mg/rtv 100mg QD to HIV+ subjects with suppressed viremia.
132 HIV+ subjects will be randomized, 1:1, to switch to RPV+DRV/r versus continue triple-drug therapy. Subjects will be switched from any PI/r-containing regimen.
The duration of the study is 96 weeks and patients will be stratified according to their HCV serostatus (Ab positive or negative), age (> or < 50 years), and immunological status (CD4<200/µL; CD4=200-500/µL; CD4>500/µL). It is planned to enroll at least 30% of female subjects.
Follow-up visits will be performed at 4, 8, 12, 24, 36, 48, 60, 72, and 96 weeks (laboratory and physical examination).
Effectiveness will be measured by determination of HIV-RNA, safety will be evaluated by determination of AST, ALT, creatinine, plasmatic and urinary phosphate, albuminuria, total cholesterol, HDL and LDL cholesterol, triglycerides at the follow-up visits.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01792570
|Contact: Stefano - Rusconi, M.D.||0039 02 firstname.lastname@example.org|
|Clinica delle Malattie Infettive, Policlinico Universitario||Recruiting|
|Bari, BA, Italy|
|Contact: Gioacchino Angarano, M.D. email@example.com|
|Principal Investigator: Gioacchino Angarano, M.D.|
|Divisione di Malattie Infettive, Ospedale S. Maria Annunziata, Antella||Recruiting|
|Firenze, FI, Italy|
|Contact: Sergio Lo Caputo, M.D. firstname.lastname@example.org|
|Principal Investigator: Sergio Lo Caputo, M.D.|
|Clinica delle Malattie Infettive, Ospedale San Martino, Università degli Studi||Recruiting|
|Genova, GE, Italy|
|Contact: Antonio Di Biagio, M.D. email@example.com|
|Principal Investigator: Antonio Di Biagio, M.D.|
|Divisione di Malattie Infettive, Ospedale San Gerardo||Recruiting|
|Monza, MB, Italy|
|Contact: Andrea Gori, M.D. firstname.lastname@example.org|
|Principal Investigator: Andrea Gori, M.D.|
|Divisione Clinicizzata di Malattie Infettive dell'Università degli Studi, Dipartimento di Scienze Biomediche e Cliniche "Luigi Sacco"||Recruiting|
|Milano, MI, Italy, 20157|
|Contact: Stefano Rusconi, M.D. email@example.com|
|Contact: Elisa Colella, M.D. firstname.lastname@example.org|
|Principal Investigator: Stefano Rusconi, M.D.|
|I e II Divisione Malattie Infettive, Azienda Ospedaliera-Polo Universitario "Luigi Sacco"||Recruiting|
|Milano, MI, Italy, 20157|
|Contact: Giuliano Rizzardini, M.D. email@example.com|
|Principal Investigator: Giuliano Rizzardini, M.D.|
|Clinica Malattie Infettive, Policlinico Universitario||Not yet recruiting|
|Modena, MO, Italy|
|Contact: Cristina Mussini, M.D. firstname.lastname@example.org|
|Principal Investigator: Cristina Mussini, M.D.|
|U.O. Malattie Infettive, Policlinico S. Matteo||Recruiting|
|Pavia, PV, Italy|
|Contact: Renato Maserati, M.D. email@example.com|
|Principal Investigator: Renato Maserati, M.D.|
|Clinica delle Malattie Infettive, Policlinico "Tor Vergata"||Recruiting|
|Roma, RM, Italy|
|Contact: Massimo Andreoni, M.D. firstname.lastname@example.org|
|Contact: Loredana Sarmati, M.D. email@example.com|
|Principal Investigator: Massimo Andreoni, M.D.|
|Istituto di Clinica delle Malattie Infettive, Università Cattolica del Sacro Cuore||Not yet recruiting|
|Roma, RM, Italy|
|Contact: Simona Di Giambenedetto, M.D. firstname.lastname@example.org|
|Principal Investigator: Simona Di Giambenedetto, M.D.|
|U.O. Malattie Infettive, Azienda Policlinico Umberto I, Università degli Studi "La Sapienza"||Recruiting|
|Roma, RM, Italy|
|Contact: Vincenzo Vullo, M.D. email@example.com|
|Contact: Gabriella D'Ettorre, M.D. firstname.lastname@example.org|
|Principal Investigator: Vincenzo Vullo, M.D.|
|Clinica delle Malattie Infettive, Ospedale Amedeo di Savoia, Università degli Studi||Recruiting|
|Torino, TO, Italy|
|Contact: Stefano Bonora, M.D. email@example.com|
|Principal Investigator: Stefano Bonora, M.D.|
|Principal Investigator:||Stefano - Rusconi, M.D.||DIBIC "Luigi Sacco", Università degli Studi di Milano, Italy|