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

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.

Study Overview

• Status: Completed
• Conditions: Human Immunodeficiency Virus
• Intervention / Treatment: Drug: Dolutegravir

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 Type: Interventional
• Enrollment (Actual): 134
• Phase: Phase 4

Contacts and Locations

Study Locations

• Netherlands
  • Zuid Holland
    • Rotterdam, Zuid Holland, Netherlands, 3000 CA
      • Erasmus Medical Center

Participation Criteria

Eligibility Criteria

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

Description

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.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / 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

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Efficacy of dolutegravir monotherapy in maintaining virological suppression in the on-treatment population	HIV-RNA <200c/ml at week 24 after baseline	24 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time to loss of virological response (TLOVR) in the OT population	Time to first of two confirmed HIV-RNA >50c/ml at least 1 week apart	1 week
Efficacy of dolutegravir monotherapy in maintaining virological suppression in the entire study population (ITT)	HIV-RNA <200c/ml at week 24 after baseline	24 weeks
Efficacy of dolutegravir monotherapy in maintaining virological suppression in the on-treatment population	HIV-RNA <50 & <200 at week 24 & 48	48 weeks
Evaluate safety of Dolutegravir monotherapy (Acquired resistance & Adverse Events according to CDC 4.0)	Acquired resistance & Adverse Events according to CDC 4.0	60 weeks
Evaluate the evolution of CD4 associated HIV-1 reservoir	Total/integrated HIV-DNA & 2LTR	48 weeks
Evaluate the number and type of INI resistance mutation in patients with virological failure	Virological failure: HIV-RNA >200c/ml	48 weeks
Evaluate CD4 cell count change	Compare baseline vs. 48 weeks after baseline	48 weeks
Evaluate changes in renal function after 24 and 48 weeks of dolutegravir monotherapy		48 weeks
Cost effectiveness of DTG monotherapy	Cost per QALY during DTG monotherapy in comparison with the costs of therapy with the patient's own cART regimen used before study inclusion	48 weeks
Evaluate change in BMD after 24 and 48 weeks of dolutegravir mono-therapy		48 weeks
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		48 weeks
Efficacy of dolutegravir monotherapy in maintaining virological suppression in the on-treatment population	HIV-RNA <200c/ml and <50 at week 12 after baseline	12 weeks

Collaborators and Investigators

• Sponsor: Erasmus Medical Center
• Investigators: Principal Investigator: Bart Rijnders, MD, PhD, Erasmus Medical Center

Publications and helpful links

General Publications

• Wijting IEA, Lungu C, Rijnders BJA, van der Ende ME, Pham HT, Mesplede T, Pas SD, Voermans JJC, Schuurman R, van de Vijver DAMC, Boers PHM, Gruters RA, Boucher CAB, van Kampen JJA. HIV-1 Resistance Dynamics in Patients With Virologic Failure to Dolutegravir Maintenance Monotherapy. J Infect Dis. 2018 Jul 24;218(5):688-697. doi: 10.1093/infdis/jiy176.
• Wijting I, Rokx C, Boucher C, van Kampen J, Pas S, de Vries-Sluijs T, Schurink C, Bax H, Derksen M, Andrinopoulou ER, van der Ende M, van Gorp E, Nouwen J, Verbon A, Bierman W, Rijnders B. Dolutegravir as maintenance monotherapy for HIV (DOMONO): a phase 2, randomised non-inferiority trial. Lancet HIV. 2017 Dec;4(12):e547-e554. doi: 10.1016/S2352-3018(17)30152-2. Epub 2017 Oct 26.

Study record dates

Study Major Dates

• Study Start (Actual): March 1, 2015
• Primary Completion (Actual): June 1, 2017
• Study Completion (Actual): July 1, 2017

Study Registration Dates

• First Submitted: March 19, 2015
• First Submitted That Met QC Criteria: March 24, 2015
• First Posted (Estimate): March 30, 2015

Study Record Updates

• Last Update Posted (Actual): January 28, 2020
• Last Update Submitted That Met QC Criteria: January 27, 2020
• Last Verified: January 1, 2020

More Information

Terms related to this study

• Additional Relevant MeSH Terms: RNA Virus Infections; Virus Diseases; Infections; Blood-Borne Infections; Communicable Diseases; Sexually Transmitted Diseases, Viral; Sexually Transmitted Diseases; Lentivirus Infections; Retroviridae Infections; Immunologic Deficiency Syndromes; Immune System Diseases; Slow Virus Diseases; HIV Infections; Acquired Immunodeficiency Syndrome; Molecular Mechanisms of Pharmacological Action; Anti-Infective Agents; Antiviral Agents; Enzyme Inhibitors; Anti-HIV Agents; Anti-Retroviral Agents; HIV Integrase Inhibitors; Integrase Inhibitors; Dolutegravir
• Other Study ID Numbers: NL51858.078.14