RPV+DRV/Cobi Dual Therapy in Subjects With HIV Controlled Infection (PROBE2)

Multicenter, National, Prospective, Open Label, Randomized, Pilot, Proof-of-concept Study on the Use of Rilpivirine Plus Darunavir/Cobicistat as Substitutive Agents in Virologic Suppressed Patients

This study evaluates efficacy and safety of rilpivirine as substitutive agent for the nucleosidic backbone of HAART in virologic suppressed patients when combined with cobicistat-boosted darunavir.

Study Overview

• Status: Unknown
• Conditions: HIV Infection
• Intervention / Treatment: Drug: Rilpivirine + darunavir/cobicistat

Detailed Description

HAART is generally based on the combination of three active drugs. Two of them, usually defined the backbone, belong to the nucleosidic analogues class (NRTI). In the last years, drugs of this class have been associated to several long-term adverse events of HAART such as lipoatrophy, cardiovascular diseases, bone and kidney toxicity. Furthermore the need of a triple drug regimen has recently been questioned as maintenance therapy in well controlled chronically treated subjects. In this setting, less drug regimens (LDR) have been proposed. LDR would allow a reduced exposure to drugs and eventually limit drug-drug interactions, drug-related toxicities and would allow treatment simplification so to enhance HAART acceptability, tolerability and persistence.

• Study Type: Interventional
• Enrollment (Actual): 1609
• Phase: Phase 4

Contacts and Locations

Study Locations

• Italy
  • Bergamo, Italy, 24128
    • Antiviral Therapy Unit, Ospedali Riuniti

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Written signed and dated informed consent to participate in the study must be given by the subject, in accordance with the International Conference of Harmonisation (ICH) Good Clinical Practice (GCP) Guideline E627 and applicable regulations, before completing any procedure related to the study.
2. HIV-1 documented infection
3. Male and female subjects > 18 years of age.
4. Males, or non-pregnant, non-lactating females of childbearing potential, as demonstrated by a negative pregnancy test, who agree to comply with any applicable contraceptive requirements of the protocol. Women of child-bearing potential with a negative pregnancy test at Screening and Day 1 should agree to use one of the following methods: Complete abstinence from penile-vaginal intercourse from 2 weeks prior to administration of IMP, throughout the study, and for at least 2 weeks after; Double barrier method (male condom/spermicide, male condom/diaphragm, diaphragm/spermicide) IUD and male condom Male partner sterilization confirmed and male condom Approved hormonal contraception and male condom Any other method with published data showing that the expected failure rate is <1% per year and use male condo Any contraception method must be used for at least 2 weeks after discontinuation of IMP.
5. Being on a stable therapy for at least 6 months.
6. SBR must be based on any 2NRTI plus a third NNRTI, PI or INI agent. Any possible registered drug is allowed among NRTI (e.g. tenofovir, lamivudine, emtricitabine and abacavir), PI (e.g. lopinavir, atazanavir, darunavir), NNRTI (efavirenz, nevirapine, rilpivirine) or INI (raltegravir, elvitegravir, dolutegravir).
7. Having a fully suppressed HIV replication as documented by 2 prior HIV-RNA tests (at least two months apart) below the detection limit (50 copies/ml).
8. Subjects and investigator must agree that participation in this study is in the best interest of the subject.

Exclusion Criteria:

1. Patients co-infected with HBV
2. Pregnancy or breast feeding.
3. Positive anamnesis for allergy to NNRTI
4. A positive historical genotypic test showing resistance-inducing mutation either toward NNRTIs or PIs
5. History or other evidence of severe illness (malignancy or OI) requiring active treatment and/or any other conditions which would make the patient, in the opinion of the investigator, unsuitable for the study.
6. Anticipated need for Hepatitis C virus (HCV) therapy during the study period
7. Treatment with any of the following agents within 28 days of Screening: radiation therapy; cytotoxic chemotherapeutic agents; any immunomodulators that alter immune responses
8. All conditions and medicinal products listed in contraindications of DRV/c and rilpivirine
9. Subjects with current or prior (previous year) history of alcohol or other substance abuse.
10. Patients who have previously been screened for or enrolled into this study and subsequently withdrawn.
11. Patients having been given investigational drugs within 12 weeks prior to screening.
12. Inability or unwillingness to provide informed consent.
13. Life expectancy < 18 months

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: RPV +DRV/cobi; The experimental receives rilpivirine (a tablet/day) and cobicistat/darunavir co-formulated tablets (a tablet day) since randomization.	Drug: Rilpivirine + darunavir/cobicistat; Switch to a dual ART
Active Comparator: baseline therapy (CAR); The control arm continues the baseline therapy (CAR) based on 3 drugs (2 NRTIs) for 24 weeks and then will be switched to receive rilpivirine (a tablet/day) and cobicistat/darunavir co-formulated tablets (a tablet day).	Drug: Rilpivirine + darunavir/cobicistat; Switch to a dual ART

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
clinical response	proportion of patients with HIV-RNA < 50 copies/ml (FDA snapshot)	24 weeks
Virological response	proportion of patients with HIV-RNA > 50 copies/ml (FDA snapshot)	24 weeks
clinical response	proportion of patients with HIV-RNA < 50 copies/ml	48 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Tolerability (number and proportion of AEs)	AEs total, drug related and leading to treatment interruption/change	24 weeks
Tolerability (number and proportion of AEs)	AEs total, drug related and leading to treatment interruption/change	48 weeks
Bone mineral density	change in bone stiffness	24 weeks
Bone mineral density	change in bone stiffness	48 weeks

Collaborators and Investigators

• Sponsor: A.O. Ospedale Papa Giovanni XXIII
• Collaborators: San Raffaele University Hospital, Italy

Publications and helpful links

General Publications

• Maggiolo F, Gianotti N, Comi L, Di Filippo E, Fumagalli L, Nozza S, Galli L, Valenti D, Rizzi M, Castagna A. Rilpivirine plus cobicistat-boosted darunavir as alternative to standard three-drug therapy in HIV-infected, virologically suppressed subjects: Final results of the PROBE 2 trial. Antivir Ther. 2021 May;26(3-5):51-57. doi: 10.1177/13596535211042226. Epub 2021 Oct 27.
• Maggiolo F, Gianotti N, Comi L, Di Filippo E, Fumagalli L, Nozza S, Galli L, Valenti D, Rizzi M, Castagna A. Rilpivirine plus cobicistat-boosted darunavir as a two-drug switch regimen in HIV-infected, virologically suppressed subjects on steady standard three-drug therapy: a randomized, controlled, non-inferiority trial (PROBE 2). J Antimicrob Chemother. 2020 May 1;75(5):1332-1337. doi: 10.1093/jac/dkaa018.

Study record dates

Study Major Dates

• Study Start (Actual): February 1, 2017
• Primary Completion (Actual): June 13, 2019
• Study Completion (Anticipated): November 30, 2019

Study Registration Dates

• First Submitted: August 13, 2019
• First Submitted That Met QC Criteria: August 19, 2019
• First Posted (Actual): August 22, 2019

Study Record Updates

• Last Update Posted (Actual): August 22, 2019
• Last Update Submitted That Met QC Criteria: August 19, 2019
• Last Verified: August 1, 2019

More Information

Terms related to this study

• Keywords: HIV; Rilpivirine; PI; NNRTI; Darunavir/cobicistat; Switch therapy; Dual ART; virologically suppressed patients
• Additional Relevant MeSH Terms: Infections; Molecular Mechanisms of Pharmacological Action; Anti-Infective Agents; Antiviral Agents; Reverse Transcriptase Inhibitors; Nucleic Acid Synthesis Inhibitors; Enzyme Inhibitors; Anti-HIV Agents; Anti-Retroviral Agents; Protease Inhibitors; Cytochrome P-450 CYP3A Inhibitors; Cytochrome P-450 Enzyme Inhibitors; HIV Protease Inhibitors; Viral Protease Inhibitors; Cobicistat; Darunavir; Rilpivirine; Cobicistat mixture with darunavir
• Other Study ID Numbers: PG23-1

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No