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The Dolutegravir Antiretroviral Mono-Therapy for HIV Trial (DOMONO)

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ClinicalTrials.gov Identifier: NCT02401828
Recruitment Status : Completed
First Posted : March 30, 2015
Last Update Posted : January 28, 2020
Sponsor:
Information provided by (Responsible Party):
Bart Rijnders, Erasmus Medical Center

Study Description
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Brief Summary:

48-week open label randomized phase IV investigator initiated intervention study. The purpose of this study is to evaluate whether HIV-1 suppression can be maintained by DTG monotherapy in HIV-1 infected, virologically suppressed patients on cART.

104 adults fulfilling the in and exclusion criteria and on stable cART will be randomized over 2 investigational arms.

The first arm will contain the direct switch population. This population will switch directly from stable cART to Dolutegravir mono-therapy on baseline visit.

The second arm will contain the delayed-switch population. This group will switch from stable cART to Dolutegravir monotherapy 24 weeks after baseline visit.

The main goal is to investigate if Dolutegravir mono-therapy could be non-inferior to cART in virological suppressed HIV-1 infected adults.

If a interim analysis (performed when 40 patients on dolutegravir monotherapy have passed week 12) shows that it is safe to continue the study, an additional 30 patients will be included on top of the 104 patients needed for the primary endpoint analysis. In contrast to the primary endpoint population, these additional 30 patients will have a CD4 nadir <200 but a CD4 >350 at the time of the screening visit. Besides that, these 30 patients will have to fulfill all other in and exclusion criteria of the primary endpoint population (specifically a viral load never >100.000). These 30 patients are part of a pilot study looking at the possibility to broaden the eligible population in a future larger randomized clinical trial.


Condition or disease Intervention/treatment Phase
Human Immunodeficiency Virus Drug: Dolutegravir Phase 4

Detailed Description:
DTG Monotherapy will be considered non-inferior to cART if the lower bound of the one sided 97.5%CI for the difference in proportion of patients reaching the primary endpoint is not lower than -12%. For this purpose, a sample size of 52 per arm would provide 80% power at alpha 0.025 to establish non-inferiority of DTG monotherapy compared with cART when the primary endpoint success rate is 95% in both treatment arms.
Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 134 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: The Dolutegravir Antiretroviral Mono-Therapy for HIV Trial
Actual Study Start Date : March 2015
Actual Primary Completion Date : June 2017
Actual Study Completion Date : July 2017

Resource links provided by the National Library of Medicine

MedlinePlus related topics: HIV/AIDS

Arms and Interventions
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Arm Intervention/treatment
Experimental: Group A - Direct Switch
Direct switch from cART to Dolutegravir mono-therapy at baseline. Dolutegravir single tablet 50mg QD, once a day. Duration = 48 weeks
 Drug: Dolutegravir
Switch from combination antiretroviral therapy to dolutegravir monotherapy
Other Names:
  • Tivicay
  • S/GSK1349572
Experimental: Group B - Delayed Switch
Delayed switch from cART to Dolutegravir mono-therapy at week 24 from baseline. Dolutegravir single tablet 50mg QD, once a day. Duration = 48 weeks
 Drug: Dolutegravir
Switch from combination antiretroviral therapy to dolutegravir monotherapy
Other Names:
  • Tivicay
  • S/GSK1349572


Outcome Measures
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Primary Outcome Measures :
  1. Efficacy of dolutegravir monotherapy in maintaining virological suppression in the on-treatment population [ Time Frame: 24 weeks ]
    HIV-RNA <200c/ml at week 24 after baseline


Secondary Outcome Measures :
  1. Time to loss of virological response (TLOVR) in the OT population [ Time Frame: 1 week ]
    Time to first of two confirmed HIV-RNA >50c/ml at least 1 week apart

  2. Efficacy of dolutegravir monotherapy in maintaining virological suppression in the entire study population (ITT) [ Time Frame: 24 weeks ]
    HIV-RNA <200c/ml at week 24 after baseline

  3. Efficacy of dolutegravir monotherapy in maintaining virological suppression in the on-treatment population [ Time Frame: 48 weeks ]
    HIV-RNA <50 & <200 at week 24 & 48

  4. Evaluate safety of Dolutegravir monotherapy (Acquired resistance & Adverse Events according to CDC 4.0) [ Time Frame: 60 weeks ]
    Acquired resistance & Adverse Events according to CDC 4.0

  5. Evaluate the evolution of CD4 associated HIV-1 reservoir [ Time Frame: 48 weeks ]
    Total/integrated HIV-DNA & 2LTR

  6. Evaluate the number and type of INI resistance mutation in patients with virological failure [ Time Frame: 48 weeks ]
    Virological failure: HIV-RNA >200c/ml

  7. Evaluate CD4 cell count change [ Time Frame: 48 weeks ]
    Compare baseline vs. 48 weeks after baseline

  8. Evaluate changes in renal function after 24 and 48 weeks of dolutegravir monotherapy [ Time Frame: 48 weeks ]
  9. Cost effectiveness of DTG monotherapy [ Time Frame: 48 weeks ]
    Cost per QALY during DTG monotherapy in comparison with the costs of therapy with the patient's own cART regimen used before study inclusion

  10. Evaluate change in BMD after 24 and 48 weeks of dolutegravir mono-therapy [ Time Frame: 48 weeks ]
  11. Exploratory analysis of blood pressure, weight, BMI, fasting serum lipids, Framingham risk score, ATP-III treatment goals and inflammatory markers after 24wks of dolutegravir mono-therapy [ Time Frame: 48 weeks ]
  12. Efficacy of dolutegravir monotherapy in maintaining virological suppression in the on-treatment population [ Time Frame: 12 weeks ]
    HIV-RNA <200c/ml and <50 at week 12 after baseline


Eligibility Criteria
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Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Documented HIV-1 positive by ELISA or Western Blot or Plasma HIV-RNA >1000 c/ml.
  • 18 years or older.
  • HIV-RNA ≤50 copies/mL for ≥24 weeks.
  • Historical baseline HIV-RNA plasma load <100.000 c/ml
  • CD4 count nadir pre-cART ≥200 cells/mm3
  • Not on strong UGT1A1 or CYP3A4 inducing agents as stated in DTG SPC.
  • General medical condition does not interfere with trial procedures (on investigators' discretion)
  • Females should have no plans of becoming pregnant during the next 18 months after the baseline visit

  • Females are eligible if:

    1. They do not plan to become pregnant during the study
    2. Negative screening pregnancy test and uses one of the following methods: 1.Abstinence from penile/vaginal intercourse during the study; 2.Double barrier contraceptive methods 1 of which must be condom.

Exclusion Criteria:

  • Previous virological failure on any ART.
  • Patient without documented anti-HBs antibodies.
  • Subjects positive for hepatitis B at screening (HBsAg+).
  • Any documented genotypic HIV-1 resistance with at least low-level resistance according to stanford HIV drug resistance database
  • No record of the historical baseline plasma viral load available
  • Subjects with concomitant CDC-C opportunistic infections within 90 days of screening.
  • Subjects with history of allergy to INI.
  • Subjects with creatinine clearance <50mL/min according to CKD-EPI.
  • Subjects with hepatic impairment of at least Child-Pugh B.
  • Exposure to experimental drug or experimental HIV-1 vaccine within 90 days of start of DTG.
  • Screening ALT >5x ULN or ALT>3xULN and bilirubin >2 ULN.
  • Patient (man or woman) planning or hoping to conceive a child/become pregnant during the study
  • Patients who cannot take DTG 2 hours before or 6 hours after antacids, calciumcarbonate or iron supplements.
Contacts and Locations
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02401828


Locations
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Netherlands
Erasmus Medical Center
Rotterdam, Zuid Holland, Netherlands, 3000 CA
Sponsors and Collaborators
Erasmus Medical Center
Investigators
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Principal Investigator: Bart Rijnders, MD, PhD Erasmus Medical Center
More Information
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Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

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Responsible Party: Bart Rijnders, MD, PhD, Erasmus Medical Center
ClinicalTrials.gov Identifier: NCT02401828    
Other Study ID Numbers: NL51858.078.14
First Posted: March 30, 2015    Key Record Dates
Last Update Posted: January 28, 2020
Last Verified: January 2020
Additional relevant MeSH terms:
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Acquired Immunodeficiency Syndrome
HIV Infections
Immunologic Deficiency Syndromes
Immune System Diseases
Blood-Borne Infections
Communicable Diseases
Infections
Sexually Transmitted Diseases, Viral
Sexually Transmitted Diseases
Lentivirus Infections
Retroviridae Infections
RNA Virus Infections
 Virus Diseases
Slow Virus Diseases
Dolutegravir
HIV Integrase Inhibitors
Integrase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Anti-HIV Agents
Anti-Retroviral Agents
Antiviral Agents
Anti-Infective Agents