Switch to Darunavir/r + Maraviroc Quaque Die in Patients With R5 Tropism by Viral DNA Genotyping (GUSTA) (GUSTA)
Switch to Darunavir/r + Maraviroc QD in Patients With R5 Tropism by Viral DNA Genotyping With Suppressed Viremia (GUSTA): a Multicenter, Open-label, Randomized Controlled Trial
Objectives of the study:
- To verify the safety and the efficacy of the study treatment, defined as the persistent control of the virus' replication at 48 weeks after the simplification to maraviroc + darunavir with ritonavir in patients with R5 tropism by viral DNA genotyping.
- To collect relevant information about the safety, the immunologic and the economic impact of this strategy.
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Undersøgelsestype
Undersøgelsestype
Tilmelding (Faktiske)
Tilmelding
Fase
Fase
- Fase 4
Kontakter og lokationer
Studiesteder
-
-
-
Rome, Italien, 00168
- Catholic University Of Sacred Heart
-
-
Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Inclusion Criteria:
- Patients treated with the same regimen including 3 HAART from at least 4 months
- Aged 18 years or older
- Who gave informed consent to the participation to the study
- With at least two viral load < 50 copies/mL in two consecutive determinations at least 6 months apart (tolerance of two weeks)
- With CD4 cell count > 200 cells/μL and absence of any opportunistic infection or AIDS-related disease for at least one year prior to the screening.
- With R5 tropism by viral DNA genotyping (geno2pheno "clonal")
- With CD4 cell count nadir>50 cell/mmc or 100 cell/mmc if previous enfuvirtide or integrase inhibitors use
Exclusion Criteria:
- With at least one major or two minor mutation conferring resistance to darunavir reported in the update list of International AIDS Society - USA , in previous resistance test
- Previous D/M or X4 viral tropism
- Previous major clinical toxicities (grade >=3) to the proposed drugs of the study
- Pregnancy or breast feeding, desire of pregnancy in the short term
- Past exposure to Chemokine Receptor 5 antagonist
- HBsAg serostatus
- Liver cirrhosis of class C (Child-Pugh)
- Sulpha drug hypersensitivity
- The presence of major non AIDS-defining diseases that, in the opinion of the investigator, may compromise the retention of the patient in the study for the necessary follow-up period.
- Estimated glomerular filtration < 30 ml/min (cockroft-Gaut; MDRD formula if black-African or african-american) at screening visit
- Hypertransaminasemia of grade IV (more than 10 times the upper normal limit) at screening visit
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Ingen (Åben etiket)
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
|
Eksperimentel: MARAVIROC, DARUNAVIR/r
Treatment simplification from a "standard" combined antiretroviral therapy including 3 drugs to Maraviroc plus Darunavir with Ritonavir.
Treatment simplification from three-drugs- to two-drugs-based antiretroviral therapy
|
Maraviroc 300 mg Darunavir 800 mg Ritonavir 100 mg
|
|
Sham-komparator: current ART with 3 drugs
Patients on HAART with three drugs and HIV RNA below 50 copies/mL
|
To continue the assumption of previous HAART
|
Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Tidsramme |
|---|---|
|
proportion of patients with virological failure (two consecutive measures of HIV-RNA higher than 50 copies/mL or a single measure higher than 1000 copies/mL) within 48 weeks at per protocol analysis, with switch=failure
Tidsramme: 48 weeks
|
48 weeks
|
Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Tidsramme |
|---|---|
|
proportion of patients with virological failure (two consecutive measures of HIV-RNA higher than 50 copies/mL or a single measure higher than 1000 copies/mL) within 96 weeks at intention-to treat analysis with missing value=Failure
Tidsramme: 96 weeks
|
96 weeks
|
|
Time to virological failure at survival analysis
Tidsramme: 48 weeks
|
48 weeks
|
|
Proportion of patients with at failure X4 tropism viral tropism (RNA or DNA genotyping)
Tidsramme: 48 weeks
|
48 weeks
|
|
Evolution of CD4 cell- cluster of differentiation 4 cell count during the 96 weeks
Tidsramme: 96 weeks
|
96 weeks
|
|
Evolution of adherence and quality of life after 24, 48 and 96 weeks
Tidsramme: 96 weeks
|
96 weeks
|
|
Evolution of maraviroc, darunavir, ritonavir plasma concentrations during the 96 weeks
Tidsramme: 96 weeks
|
96 weeks
|
|
Evolution of metabolic parameters at 96 weeks
Tidsramme: 96 weeks
|
96 weeks
|
|
Change of the results of neurocognitive tests at 48 and 96 weeks
Tidsramme: 96 weeks
|
96 weeks
|
|
Modification of bone density and subcutaneous fat at 48 and 96 weeks
Tidsramme: 96 weeks
|
96 weeks
|
|
Modification of Intima-Media Thickness and Flow Mediated Dilation at 48 and 96 weeks
Tidsramme: 96 weeks
|
96 weeks
|
|
Economic impact of Darunavir/ritonavir+ Maraviroc versus Highly Active Antiretroviral Therapy
Tidsramme: 96 weeks
|
96 weeks
|
Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Efterforskere
Efterforskere
- Ledende efterforsker: Andrea De Luca, Prof, Catholic University of the Sacred Heart
Datoer for undersøgelser
Studer store datoer
Studiestart
Studiestart
Primær færdiggørelse (Faktiske)
Primær færdiggørelse
Studieafslutning (Faktiske)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Skøn)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Skøn)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Nøgleord
Yderligere relevante MeSH-vilkår
- RNA-virusinfektioner
- Virussygdomme
- Infektioner
- Blodbårne infektioner
- Overførbare sygdomme
- Seksuelt overførte sygdomme, virale
- Seksuelt overførte sygdomme
- Lentivirus infektioner
- Retroviridae infektioner
- Immunologiske mangelsyndromer
- Sygdomme i immunsystemet
- HIV-infektioner
- Molekylære mekanismer for farmakologisk virkning
- Anti-infektionsmidler
- Antivirale midler
- Enzymhæmmere
- Anti-HIV-midler
- Proteasehæmmere
- HIV-proteasehæmmere
- Virale proteasehæmmere
- HIV-fusionshæmmere
- Virale fusionsproteinhæmmere
- CCR5-receptorantagonister
- Maraviroc
- Darunavir
- Anti-retrovirale midler
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- 2010-023316-13
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