Treatment of Abnormal Adipose Tissue Accumulation in Human Immunodeficiency Virus (HIV) Patients

A Phase III, Multi-Center, Randomized, Double-Blind, Placebo-Controlled, Parallel Group Study of the Safety and Efficacy of Serostim®, r-hGH in the Treatment and Maintenance of Human Immunodeficiency HIV-Associated Adipose Redistribution Syndrome, or HARS

The primary objective of the study is to determine if Serostim® 4 mg administered daily for 12 weeks as treatment for the abnormal fat accumulation and distribution associated with HIV-associated Adipose Redistribution Syndrome (HARS) reduces Visceral Adipose Tissue (VAT, measured by CT scan) more effectively than placebo.

Study Overview

• Status: Completed
• Conditions: HIV Infections; Lipodystrophy
• Intervention / Treatment: Drug: Placebo; Drug: Serostim® 4 mg; Drug: Serostim® 2 mg

• Study Type: Interventional
• Enrollment (Actual): 326
• Phase: Phase 3

Contacts and Locations

Study Locations

• Canada
  • British Columbia
    • Vancouver, British Columbia, Canada, V6Z 1Y6
      • AIDS Research Program
• United States
  • Alabama
    • Birmingham, Alabama, United States, 35294
      • University of Alabama/Birmingham
  • California
    • Los Angeles, California, United States, 90095
      • CARE CLINIC - UCLA Medical Center
    • Palm Springs, California, United States, 92262
      • 1401 N. Palm Canyon
    • Sacramento, California, United States, 95817
      • Trials Unit Div of Infectious and Immunologic Diseases
    • San Diego, California, United States, 92103
      • UCSD - AntiViral Research Center
    • San Francisco, California, United States, 94118
      • Kaiser Permanente
    • San Francisco, California, United States, 94110
      • University of California, San Francisco - Div. of Endocrinology
    • San Francisco, California, United States, 94121
      • Northern California Institute for Research and Education, Inc.
    • Torrance, California, United States, 90502
      • Harbor-UCLA Medical Ctr Research & Education Institute
    • West Hollywood, California, United States, 90069
      • AIDS Alliance
  • Colorado
    • Denver, Colorado, United States, 80262
      • University of Colorado Health Sciences Center
  • District of Columbia
    • Washington, D.C., District of Columbia, United States, 20036
      • 1640 Rhode Island Avenue, N.W.
  • Florida
    • Fort Lauderdale, Florida, United States, 33316
      • Office Of Dr Gary Richmond
    • Miami, Florida, United States, 33133
      • 3661 South Miami Avenue
    • Miami, Florida, United States, 33137
      • Care Resources
    • Sarasota, Florida, United States, 34239
      • Infectious Disease Associates
  • Georgia
    • Atlanta, Georgia, United States, 30308
      • AIDS Research Consortium of Atlanta
  • Illinois
    • Chicago, Illinois, United States, 60612
      • Rush University Medical Center
  • Indiana
    • Indianapolis, Indiana, United States, 46202
      • Indiana University Infectious Disease Research Clinic
  • Massachusetts
    • Boston, Massachusetts, United States, 02111
      • Tufts University School of Medicine
    • Boston, Massachusetts, United States, 02215
      • Community Research Initiative of New England
    • Springfield, Massachusetts, United States, 01107
      • Community Research Initiative of New England
  • Minnesota
    • Minneapolis, Minnesota, United States, 55415
      • Hennepin County Medical Center
  • New York
    • Albany, New York, United States, 12208
      • Albany Medical College
    • New York, New York, United States, 10025
      • St. Luke's Roosevelt Hospital
    • New York, New York, United States, 10021
      • Weill Medical College of Cornell Universtiy
    • The Bronx, New York, United States, 10467
      • Bronx Women's Interagency HIV Study
  • Texas
    • Austin, Texas, United States, 78705
      • Central Texas Clincial research
  • Virginia
    • Annandale, Virginia, United States, 22003
      • IDP Research
  • Washington
    • Spokane, Washington, United States, 99204
      • Office of Daniel Coulston, M.D.

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 60 years (ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Have written laboratory documentation of an HIV infection by one of the following methods:

   • Detectable viral load measured by polymerase chain reaction (PCR) amplification, branched chain DNA (bDNA) signal amplification or the presence of p24 antigen.
   • Presence of HIV antibodies confirmed by either Western blot or immunofluorescence assay.

   Written laboratory documentation of an HIV infection must be obtained prior to randomization. In the absence of documented historical confirmation, an assay of HIV antibodies will be included in the Screening Laboratory Panel. Results will be confirmed with a Western Blot.

2. Have evidence of excess abdominal adipose deposition when measured by the anthropometric methodology, using the following cut off values:

   • Men: Waist circumference >88.2 cm AND waist: hip ratio >= 0.95.
   • Women: Waist circumference >75.3 cm AND waist: hip ratio >= 0.9.
3. Are taking antiretroviral medication(s) which is (are) approved or is (are) available under a Treatment IND. The regimen must have remained stable for 30 days prior to study entry. Subjects must also agree not to discontinue or to change their regimen for the duration of the study except as judged medically necessary.

4. Have parameter values less than the following limits (using results from the central laboratory):

   • AST, ALT, and amylase <= 3 times the upper limit of normal (Screening).
   • Fasting triglycerides <= 1,000 mg/dL (Screening).
   • Fasting glucose <110 mg/dL (Screening).
   • Two-hour (120 minute) glucose <140 mg/dL (Screening).
5. Weight >= 36 kg (79.3 lb)
6. Be between 18 and 60 years of age (inclusive) unless local law dictates different limits.
7. Sufficiently literate in English to be able to comprehend and complete the Quality of Life Questionnaire.
8. Willing and able to comply with the protocol for the duration of the study.
9. Have voluntarily provided written informed consent (with subject authorization under HIPAA), prior to performing any study-related procedure that is not part of normal medical care, and with the understanding that the subject may withdraw consent at any time without prejudice to future medical care.

10. Female subjects must:

    1. Be post menopausal (>= 1 year) or surgically sterilized (i.e., have undergone tubal ligation or hysterectomy)

       or

    2. Use a contraceptive method for the duration of the study such as:

       • Hormonal contraceptive
       • Intra uterine device
       • Diaphragm with spermicide, or condom with spermicide.

       And

    3. Must be neither pregnant nor breast feeding.
    4. Confirmation that female subjects of childbearing potential are not pregnant must be established by a negative beta-hCG serum pregnancy test during the 14-day screening period prior to Study Day 1. If the beta-hCG serum pregnancy test is performed more than 7 days prior to Study Day 1, a urine pregnancy test must be performed by the site laboratory on Study Day 1 to confirm a negative test result.

Exclusion Criteria:

1. Have an active AIDS-defining opportunistic complication (OC) as defined by the CDC or have had an untreated or suspected serious systemic infection, or have had a persistent fever >= 101°F (38.3°C) during the 30 days prior to study entry.
2. Any active or past history of malignancy, except for localized cutaneous Kaposi's sarcoma (fewer than 10 lesions, none of which are larger than 2 cm, and not on active therapy). Such exceptions must be confirmed in writing by the Serono Study Director.
3. Have a CNS mass or active CNS process associated with neurological findings.
4. Have unstable or untreated hypertension, defined as >= 140/90 mm Hg at the time of the Screening Visit, and/or have initiated or changed antihypertensive therapy in the 30 days prior to Study Day 1.
5. Have an acute critical illness treated in an intensive care unit, e.g., due to complications following open heart or abdominal surgery, multiple accidental trauma, or acute respiratory failure.
6. Have a recent history of sleep apnea or intermittent upper respiratory obstruction.
7. Have any condition, which interferes with informed consent or protocol compliance including, but not limited to, active substance abuse and/or dementia.

8. Are unable to comply with the Concomitant Therapy restrictions including:

   • therapy for obesity including therapy with anorexigenic or fat reducing drugs
   • anti-diabetic or insulin sensitizing medications
   • systemic glucocorticoids
   • systemic chemotherapy, interferon or radiation therapy treatment
   • androgenic agents including, but not limited to testosterone, nandrolone, oxandrolone, oxymetholone, etc. (testosterone replacement therapy for hypogonadism is the exception to this exclusion and will be allowed if started > 30 days prior to Study Day 1)
   • progestational agents, unless used for oral contraception or post-menopausal hormone replacement therapy
   • appetite stimulants
   • investigational agents, unless approved in advance by the study medical director. Specifically, experimental antiretroviral agents are disallowed, unless available under a treatment IND or expanded access program (30 days).
   • Liposuction or other elective plastic surgery
   • AIDS wasting therapy or prior growth hormone treatment other than study drug (for 12 months prior to the screening visit)

9. Have ever been diagnosed with any of the following conditions:

   • Pancreatitis
   • Carpal tunnel syndrome (unless resolved by surgical release)
   • Diabetes mellitus
   • Angina pectoris
   • Coronary artery disease
   • Any disorder associated with moderate to severe edema (e.g., ascites, nephrotic syndrome, congestive heart failure, lymphedema).
10. Allergy or hypersensitivity to growth hormone.
11. Are participating in any other clinical studies.

In order to participate in this trial a subject must meet all of the inclusion and exclusion criteria specified above. Requests for protocol exceptions/exemptions must come from a participating, fully initiated site at which a prospective patient has consented to undergo screening. Exceptions/exemptions are only allowed by the Trial Director. There is no program in place to allow drug for a single patient IND, or for an expanded access protocol. This statement holds true for both children and adults.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: DOUBLE

Number of Arms

5

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
PLACEBO_COMPARATOR: Period I: Placebo; Subjects will receive placebo matched to serostim® as subcutaneous injection daily for a period of 12 weeks.	Drug: Placebo; Placebo matched to serostim® as subcutaneous injection.
EXPERIMENTAL: Period I: Serostim® 4 mg; Subjects will receive Serostim® as subcutaneous injection at a maximum dose of 4 milligram (mg) per day based on body weight for a period of 12 weeks.	Drug: Serostim® 4 mg; Serostim® as subcutaneous injection at a maximum dose of 4 milligram (mg) per day based on body weight.; Other Names: recombinant human growth hormone (r-hGH)
EXPERIMENTAL: Period II: Serostim® 4 mg to Placebo; All subjects who will be initially randomized to Serostim® 4 mg arm in Period I and will receive placebo matched to Serostim® on alternate days for 24 weeks in Period II.	Drug: Placebo; Placebo matched to serostim® as subcutaneous injection.
EXPERIMENTAL: Period II: Serostim® 4 mg to Serostim® 2 mg; All subjects who will be initially randomized to Serostim® 4 mg arm in Period I and will receive Serostim® 2 mg on alternate days for 24 weeks in Period II.	Drug: Serostim® 2 mg; Serostim® 2 mg as subcutaneous injection on alternate days.; Other Names: recombinant human growth hormone (r-hGH)
EXPERIMENTAL: Period II: Placebo to Placebo/Serostim® 4 mg; All subjects who will be initially randomized to Placebo arm in Period I continue receiving placebo matched to Serostim® on alternate days for 12 weeks followed by Serostim® 4 mg daily 12 weeks.	Drug: Placebo; Placebo matched to serostim® as subcutaneous injection.; Drug: Serostim® 4 mg; Serostim® as subcutaneous injection at a maximum dose of 4 milligram (mg) per day based on body weight.; Other Names: recombinant human growth hormone (r-hGH)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Treatment Period I: Change From Baseline in Absolute Area of Visceral Adipose Tissue (VAT) at Week 12	Absolute area of VAT was measured by cross-sectional computed tomography (CT) scan at the level of the L4-5 inter-vertebral disk. CT scanning was to be used to assess the cross sectional area of abdominal fat and its distribution between the visceral and subcutaneous compartments, as measured at L4-L5.	Baseline, Week 12

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Treatment Period I: Change From Baseline in Trunk Fat at Week 12	Changes in trunk fat was measured as changes in mass (kg) on Dual-Energy X-Ray Absorptiometry (DXA) Scan.	Baseline, Week 12
Change From Baseline in Patient Reported Outcome of Body Image Distress at Week 12	Body image distress was assessed on a scale ranging from 0 to 100, where 0 = Extremely Upsetting and 100 = Extremely Encouraging.	Baseline, Week 12
Treatment Period I: Change From Baseline in Non- High-density Lipoprotein (Non-HDL) Cholesterol at Week 12	Lipid profile data was analyzed for Non-HDL Cholesterol.	Baseline, Week 12
Treatment Period II: Failure Rate at Week 36 Based on Visceral Adipose Tissue (VAT) For Subjects Who Received Serostim® 4 mg in Period I	Failure rate based on VAT was assessed by CT scan at L4-L5. The failure rate was defined as the percentage of subjects who regained >50% of their VAT lost in Treatment Period I. This outcome was to be assessed for subjects who received Serostim® 4 mg in Period I.	Week 36

Collaborators and Investigators

• Sponsor: EMD Serono

Publications and helpful links

Helpful Links

• Full FDA approved prescribing information can be found here
• Link to PubMed
• Related Info

Study record dates

Study Major Dates

• Study Start (ACTUAL): May 28, 2004
• Primary Completion (ACTUAL): September 28, 2005
• Study Completion (ACTUAL): September 28, 2005

Study Registration Dates

• First Submitted: May 13, 2004
• First Submitted That Met QC Criteria: May 14, 2004
• First Posted (ESTIMATE): May 17, 2004

Study Record Updates

• Last Update Posted (ACTUAL): July 20, 2018
• Last Update Submitted That Met QC Criteria: October 2, 2017
• Last Verified: September 1, 2017

More Information

Terms related to this study

• Keywords: Growth hormone; Serostim®; Human Adipose Redistribution Syndrome; Human Immunodeficiency Virus lipodystrophy
• Additional Relevant MeSH Terms: Metabolic Diseases; Skin Diseases; Immune System Diseases; Lipid Metabolism Disorders; Skin Diseases, Metabolic; Immunologic Deficiency Syndromes; Lipodystrophy; Physiological Effects of Drugs; Hormones, Hormone Substitutes, and Hormone Antagonists; Hormones
• Other Study ID Numbers: 24380