Study of PRO 140 SC as Single Agent Maintenance Therapy in Virally Suppressed Subjects With CCR5-tropic HIV-1 Infection

• ClinicalTrials.gov Identifier: NCT02859961
• Recruitment Status: Active, not recruiting
• First Posted: August 9, 2016
• Last Update Posted: January 14, 2022
• Sponsor: CytoDyn, Inc.
• Information provided by (Responsible Party): CytoDyn, Inc.

Study Description

Brief Summary:

This study is a Phase 2b/3, multi-center study designed to evaluate the efficacy, safety, and tolerability of the strategy of shifting clinically stable patients receiving suppressive combination antiretroviral therapy to PRO 140 monotherapy and maintaining viral suppression for 48 weeks following study entry.

Consenting patients will be shifted from combination antiretroviral regimen to weekly PRO 140 monotherapy for 48 weeks during the Treatment Phase with the one week overlap of existing retroviral regimen and PRO 140 at the beginning of the study treatment and also one week overlap at the end of the treatment in subjects who do not experience virologic failure.

Condition or disease	Intervention/treatment	Phase
HIV	Drug: PRO 140 (350 mg); Drug: PRO 140 (525 mg); Drug: PRO 140 (700 mg)	Phase 2; Phase 3

Detailed Description:

The primary objective is to assess the treatment strategy of using PRO 140 SC as long-acting, single-agent maintenance therapy for the chronic suppression of CCR5-tropic HIV-1 infection. In addition, the prognostic factors of therapeutic success of PRO 140 monotherapy will be evaluated.

The secondary objective of the trial is to assess the clinical efficacy, safety and tolerability parameters following substitution of combination antiretroviral therapy with weekly PRO 140 monotherapy.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 556 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: A Phase 2b/3, Multicenter Study to Assess the Treatment Strategy of Using PRO 140 SC as Long-Acting Single-Agent Maintenance Therapy for 48 Weeks in Virologically Suppressed Subjects With CCR5-tropic HIV-1 Infection
• Actual Study Start Date: July 11, 2016
• Actual Primary Completion Date: September 16, 2020
• Estimated Study Completion Date: June 15, 2022

Arms and Interventions

Arm	Intervention/treatment
Experimental: PRO 140 SC 350 mg weekly injection (Group A); PRO 140 350 mg (175 mg/mL) SC injections per week	Drug: PRO 140 (350 mg); PRO 140 350 mg (175 mg/mL) SC injection per week; Other Name: Leronlimab
Experimental: PRO 140 SC 525 mg weekly injections (Group B); PRO 140 525 mg (175 mg/mL) SC injections per week	Drug: PRO 140 (525 mg); PRO 140 525 mg (175 mg/mL) SC injection per week; Other Name: Leronlimab
Experimental: PRO 140 SC 700 mg weekly injections (Group C); PRO 140 700 mg (175 mg/mL) SC injections per week	Drug: PRO 140 (700 mg); PRO 140 700 mg (175 mg/mL) SC injection per week; Other Name: Leronlimab

Outcome Measures

Primary Outcome Measures :

1. Proportion of participants who remain on PRO 140 monotherapy regimen at the end of week 48 without experiencing virologic failure [ Time Frame: 48 weeks ]

Secondary Outcome Measures :

1. Proportion of participants experiencing virologic failure while on PRO 140 monotherapy regimen [ Time Frame: 48 weeks ]
2. Time to virologic failure after initiating PRO 140 monotherapy [ Time Frame: 48 weeks ]
3. Proportion of participants achieving viral suppression (HIV-1 RNA < 50 copies/mL) after experiencing virologic failure. [ Time Frame: 48 weeks ]
4. Time to achieving viral suppression (HIV-1 RNA < 50 copies/mL) after experiencing virologic failure [ Time Frame: 48 weeks ]
5. Proportion of participants with viral suppression (HIV-1 RNA < 50 copies/mL) at week 48 from the start of PRO 140 Treatment Phase. [ Time Frame: 48 weeks ]
6. Measurement of treatment adherence to the PRO 140 monotherapy regimen [ Time Frame: 48 weeks ]
7. Total time that participants remain off combination ART regimen, defined as the time between start of PRO 140 monotherapy and restart of combination ART Regimen [ Time Frame: 48 weeks ]
8. Mean change in CD4 cell count, at each visit within the Treatment Phase [ Time Frame: 48 weeks ]
9. Proportion of participants experiencing emerging resistance exhibited by fold increase in maraviroc and PRO 140 FC between baseline and the time of virologic failure, as a measure of post-baseline phenotypic resistance [ Time Frame: 48 weeks ]
10. Central Nervous System (CNS) sub-study: Level of HIV-1 RNA in CSF at T1 (prior to first dose of PRO 140), T4, T16 and VF visits [ Time Frame: 48 weeks ]
11. Central Nervous System (CNS) sub-study: PRO 140 concentration in CSF at T1 (prior to first dose of PRO 140), T4, T16 and VF visits [ Time Frame: 48 weeks ]
12. Central Nervous System (CNS) sub-study: Relationship between PRO 140 concentration in plasma and CSF [ Time Frame: 48 weeks ]
13. Central Nervous System (CNS) sub-study: Relationship between PRO 140 concentration in CSF and HIV-1 RNA in CSF [ Time Frame: 48 weeks ]
14. Genitourinary (GU) sub-study: Level of HIV-1 RNA in genital secretion at T1 (prior to first dose of PRO 140), T4, T16 and VF visits. [ Time Frame: 48 weeks ]
15. Genitourinary (GU) sub-study: PRO 140 concentration in genital secretion at T1 (prior to first dose of PRO 140), T4, T16 and VF visits. [ Time Frame: 48 weeks ]
16. Genitourinary (GU) sub-study: Relationship between PRO 140 concentration in plasma and genital secretion [ Time Frame: 48 weeks ]
17. Genitourinary (GU) sub-study: Relationship between PRO 140 concentration and HIV-1 RNA in genital secretion [ Time Frame: 48 weeks ]

Other Outcome Measures:

1. Tolerability of repeated subcutaneous administration of PRO 140 as assessed by study participants (using Visual Analogue Scale) [ Time Frame: 48 weeks ]
2. Tolerability of repeated subcutaneous administration of PRO 140 as assessed by investigator evaluation of injection site reactions. [ Time Frame: 48 weeks ]
3. Frequency of Grade 3 or 4 adverse events as defined by the DAIDS Adverse Event scale [ Time Frame: 48 weeks ]
4. Frequency of Treatment-emergent serious adverse events [ Time Frame: 48 weeks ]

Eligibility Criteria

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

Criteria

Inclusion Criteria:

1. Males and females, age ≥18 years
2. Receiving combination antiretroviral therapy for last 24 weeks
3. No change in ART within last 4 weeks prior to Screening Visit
4. Subject has two or more potential alternative approved ART drug options to consider.
5. Exclusive CCR5-tropic virus at Screening Visit
6. Plasma HIV-1 RNA < 50 copies/mL at Screening Visit
7. CD4 cell count of > 200 cells/mm3 since initiation of anti-retroviral therapy
8. CD4 cell count of > 350 cells/mm3 in preceding 24 weeks and at Screening Visit

9. Laboratory values at Screening of:

   1. Absolute neutrophil count (ANC) ≥ 750/mm3
   2. Hemoglobin (Hb) ≥ 10.5 gm/dL (male) or ≥ 9.5 gm/dL (female)
   3. Platelets ≥ 75,000 /mm3
   4. Serum alanine transaminase (SGPT/ALT) < 5 x upper limit of normal (ULN)
   5. Serum aspartate transaminase (SGOT/AST) < 5 x ULN
   6. Bilirubin (total) < 2.5 x ULN unless Gilbert's disease is present or subject is receiving atazanavir in the absence of other evidence of significant liver disease
   7. Creatinine ≤ 1.5 x ULN
10. Clinically normal resting 12-lead ECG at Screening Visit or, if abnormal, considered not clinically significant by the Principal Investigator.
11. Both male and female patients and their partners of childbearing potential must agree to use 2 medically accepted methods of contraception during the course of the study.
12. Willing and able to participate in all aspects of the study, including use of SC medication, completion of subjective evaluations, attendance at scheduled clinic visits, and compliance with all protocol requirements as evidenced by providing written informed consent.

Exclusion Criteria:

1. CXCR4-tropic virus or dual/mixed tropic (R5X4) virus determined by the Trofile™ DNA Assay
2. Hepatitis B infection as manifest by the presence of Hepatitis B surface antigen (HBsAg)
3. Any active infection or malignancy requiring acute therapy (with the exception of local cutaneous Kaposi's sarcoma)
4. Laboratory test values ≥ grade 4 DAIDS laboratory abnormality.
5. Females who are pregnant, lactating, or breastfeeding, or who plan to become pregnant during the study
6. Unexplained fever or clinically significant illness within 1 week prior to the first study dose
7. Any vaccination within 2 weeks prior to the first study dose or during the study.
8. Subjects who have failed on a maraviroc containing regimen.
9. Subjects weighing < 35kg
10. History of anaphylaxis to any oral or parenteral drugs
11. History of Bleeding Disorder or patients on anti-coagulant therapy
12. Participation in an experimental drug trial(s) within 30 days of the Screening Visit
13. Any known allergy or antibodies to the study drug or excipients

14. Treatment with any of the following:

    1. Radiation or cytotoxic chemotherapy with 30 days prior to the screening visit
    2. Immunosuppressants within 60 days prior to the screening visit
    3. Immunomodulating agents (e.g., interleukins, interferons), hydroxyurea, or foscarnet within 60 days prior to the screening visit

    4. Oral or parenteral corticosteroids within 30 days prior to the Screening Visit. Subjects on chronic steroid therapy > 5 mg/day will be excluded with the following exception:

       • Subjects on inhaled, nasal, or topical steroids will not be excluded
15. 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

Locations

United States, California

CD03 Investigational site

La Mesa, California, United States, 91942

CD03 Investigational site

Palm Springs, California, United States, 92262

CD03 Investigational site

San Francisco, California, United States, 94115

United States, Connecticut

CD03 Investigational site

New Haven, Connecticut, United States, 06510

CD03 Investigational site

Norwalk, Connecticut, United States, 06850

United States, Florida

CD03 Investigational site

Fort Pierce, Florida, United States, 34982

CD03 Investigational site

Orlando, Florida, United States, 32803

CD03 Investigational site

West Palm Beach, Florida, United States, 33401

United States, Kansas

CD03 Investigational site

Wichita, Kansas, United States, 67214

United States, Nevada

CD03 Investigational site

Las Vegas, Nevada, United States, 89109

United States, New York

CD03 Investigational site

New York, New York, United States, 10011

CD03 Investigational site

Syracuse, New York, United States, 13210

Sponsors and Collaborators

CytoDyn, Inc.

More Information

• Responsible Party: CytoDyn, Inc.
• ClinicalTrials.gov Identifier: NCT02859961
• Other Study ID Numbers: PRO 140_CD03
• First Posted: August 9, 2016
• Last Update Posted: January 14, 2022
• Last Verified: September 2021

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: Undecided

Additional relevant MeSH terms:

Infections; Leronlimab; HIV Antibodies; HIV Fusion Inhibitors; Viral Fusion Protein Inhibitors; Molecular Mechanisms of Pharmacological Action; Anti-HIV Agents; Anti-Retroviral Agents; Antiviral Agents; Anti-Infective Agents; Immunologic Factors; Physiological Effects of Drugs