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Report for Clinical Trial NCT03683524

Developed by Shray Alag, 2020.
SNP Clinical Trial Gene

Efficacy and Safety of a Simplification Strategy Based on Dolutegravir and Darunavir / Cobicistat vs Optimized Treatment in Suppressed HIV-1-infected Patients Carrying Archived Multidrug Resistance Mutations.

The availability of antiretroviral therapy has led to a reduction in morbidity and mortality in patients with chronic HIV infection. The treatment, however, is not free of side effects, has potential interactions with other medications, is expensive and can be complex, especially in those patients who are very experienced and with mutations that give them resistance to multiple drugs. For this reason, the development of simplification strategies that avoid unnecessary exposure to antiretroviral agents remains of great interest. This is a simplification study, in which the investigators try to evaluate that with less medication the investigator can maintain the same virological control of the disease. This would mean a lower burden of medication for patients, facilitating its administration and reducing the number of unwanted side effects. Specifically, the investigators intend to evaluate the treatment with Darunavir / cobicistat plus Dolutegravir as a simplification strategy, since both drugs are taken once a day, have a powerful antiviral activity, even against antiretroviral resistant viruses, and are among the best tolerated (with fewer side effects). The results reported in some observational studies suggest that two-drug therapy (bitherapy) as a simplification strategy could also be safe and effective, however, as far as the investigators know, there are no data and clinical trials that specifically evaluate darunavir / cobicistat plus dolutegravir as a strategy of simplification.

NCT03683524 HIV-1 Infection

2 Interventions

Name: Dolutegravir (DTG) plus Darunavir/cobicistat (DRV/cobi).

Description: bitherapy based on DTG (50 mg QD) plus DRV/cobi (800/150 mg QD)
Type: Drug
Group Labels: 1

Experimental group

Name: Current ART

Description: To continue with their current ART
Type: Drug
Group Labels: 1

Control group


Primary Outcomes

Description: HIV-1 RNA < 50 copies/mL using a Time to Loss of Virological Response (TLOVR).

Measure: Plasma HIV-1 RNA < 50 copies/mL at 48 weeks

Time: week 48

Secondary Outcomes

Description: Percentage of patients developing ART-associated adverse events leading to treatment discontinuation.

Measure: Percentage of patients developing ART-associated adverse events

Time: Since baseline to week 48

Description: CD4+ cell count changes

Measure: Changes in CD4+ cell count

Time: Since baseline to week 48

Description: Emergence of new mutations in HIV-1 protease and integrase assessed with a genotyping test (attempted on any post Day 1 sample with HIV-1 RNA ≥ 50 copies/mL).

Measure: Emergence of new mutations in HIV-1 protease and integrase

Time: Baseline and in case of virological failure, defined as ≥ 50 copies/mL in 2 consecutive determinations or a single HIV-1 RNA values > 1000 copies/mL. We can observe a virological failure throughout the study (from baseline to week 48)

Description: HIV-1 RNA< 50 copies/mL at 24 weeks by TLOVR

Measure: Plasma HIV-1 RNA < 50 copies/mL at 24 weeks

Time: Week 24

Description: HIV-1 RNA < 50 copies/mL at 24 and 48 weeks using the FDA snapshot analysis (sensitivity analysis).

Measure: Plasma HIV-1 RNA < 50 copies/mL at 24 and 48 weeks

Time: Week 24 and 48

Description: Description of plasmatic trough levels of DTG and DRV/cobi in the experimental group, and in those participants experiencing virological failure.

Measure: DTG and DRV/cobi plasma concentration

Time: Week 4

Description: ART prices

Measure: Cost associated with the antirretroviral treatment of the study

Time: Since baseline to week 48

Description: Prices of clinical controls during the study

Measure: Estimated costs of clinical controls

Time: Since baseline to week 48

Measure: Genotyping tests cost

Time: At virological failure, defined as ≥ 50 copies/mL in 2 consecutive determinations or a single HIV-1 RNA values > 1000 copies/mL. We can observe a virological failure throughout the study (from baseline to week 48)

Purpose: Treatment

Allocation: Randomized

Parallel Assignment


There are 11 SNPs

SNPs


1 E138A

T66I, 74M, E92Q, T97A, F121Y, E138A/K, G140A/S, Y143R/H/C, S147G, Q148H/K/R, N155H AND R263K) in historical genotyping tests. --- T66I --- --- E92Q --- --- T97A --- --- F121Y --- --- E138A ---


2 E92Q

T66I, 74M, E92Q, T97A, F121Y, E138A/K, G140A/S, Y143R/H/C, S147G, Q148H/K/R, N155H AND R263K) in historical genotyping tests. --- T66I --- --- E92Q ---


3 F121Y

T66I, 74M, E92Q, T97A, F121Y, E138A/K, G140A/S, Y143R/H/C, S147G, Q148H/K/R, N155H AND R263K) in historical genotyping tests. --- T66I --- --- E92Q --- --- T97A --- --- F121Y ---


4 G140A

T66I, 74M, E92Q, T97A, F121Y, E138A/K, G140A/S, Y143R/H/C, S147G, Q148H/K/R, N155H AND R263K) in historical genotyping tests. --- T66I --- --- E92Q --- --- T97A --- --- F121Y --- --- E138A --- --- G140A ---


5 N155H

T66I, 74M, E92Q, T97A, F121Y, E138A/K, G140A/S, Y143R/H/C, S147G, Q148H/K/R, N155H AND R263K) in historical genotyping tests. --- T66I --- --- E92Q --- --- T97A --- --- F121Y --- --- E138A --- --- G140A --- --- Y143R --- --- S147G --- --- Q148H --- --- N155H ---


6 Q148H

T66I, 74M, E92Q, T97A, F121Y, E138A/K, G140A/S, Y143R/H/C, S147G, Q148H/K/R, N155H AND R263K) in historical genotyping tests. --- T66I --- --- E92Q --- --- T97A --- --- F121Y --- --- E138A --- --- G140A --- --- Y143R --- --- S147G --- --- Q148H ---


7 R263K

T66I, 74M, E92Q, T97A, F121Y, E138A/K, G140A/S, Y143R/H/C, S147G, Q148H/K/R, N155H AND R263K) in historical genotyping tests. --- T66I --- --- E92Q --- --- T97A --- --- F121Y --- --- E138A --- --- G140A --- --- Y143R --- --- S147G --- --- Q148H --- --- N155H --- --- R263K ---


8 S147G

T66I, 74M, E92Q, T97A, F121Y, E138A/K, G140A/S, Y143R/H/C, S147G, Q148H/K/R, N155H AND R263K) in historical genotyping tests. --- T66I --- --- E92Q --- --- T97A --- --- F121Y --- --- E138A --- --- G140A --- --- Y143R --- --- S147G ---


9 T66I

T66I, 74M, E92Q, T97A, F121Y, E138A/K, G140A/S, Y143R/H/C, S147G, Q148H/K/R, N155H AND R263K) in historical genotyping tests. --- T66I ---


10 T97A

T66I, 74M, E92Q, T97A, F121Y, E138A/K, G140A/S, Y143R/H/C, S147G, Q148H/K/R, N155H AND R263K) in historical genotyping tests. --- T66I --- --- E92Q --- --- T97A ---


11 Y143R

T66I, 74M, E92Q, T97A, F121Y, E138A/K, G140A/S, Y143R/H/C, S147G, Q148H/K/R, N155H AND R263K) in historical genotyping tests. --- T66I --- --- E92Q --- --- T97A --- --- F121Y --- --- E138A --- --- G140A --- --- Y143R ---



HPO Nodes