Retrospective/Prospective Pilot Study to Evaluate Efficacy and Safety of Switching to BIC/FTC/TAF in PWH With a Previous Virological Failure Under CAB/RPV LAI (BICPREVIR)
This study is a pilot, multi-center, observational retrospective-prospective study, with two different Parts, as follows:
- Part 1(retrospective and prospective part): to evaluate efficacy and safety of switching to BIC/FTC/TAF in People living with HIV (PWH) who previously failed CAB/RPV LAI in the last three years and received in the last three years boosted PI since any INSTI mutations were detected on RNA and/or DNA through NGS at failure
- Part 2 (prospective part only): to evaluate efficacy and safety of switching directly to BIC/FTC/TAF in PWH who failed CAB/RPV LAI without any RAMs on RNA and/or DNA through NGS considered of potential relevance for bictegravir
Inclusion Criteria:
- PWH with age >18 years
- PWH with a confirmed virological failure on CAB/RPV LAI in the last three years
- PWH without RAMs versus FTC and TAF
Study population: 30 subjects failing CAB/RPV LAI will be included in the study
Studieoversigt
Status
Status
Betingelser
Betingelser
Detaljeret beskrivelse
BIC/FTC/TAF has been studied in treatment-naïve and virologically suppressed people with HIV (PWH) with a cumulative exposure of >3.1 million person-years of treatment.
Cabotegravir/Rilpivirine (CAB/RPV) is the first long-acting injectable (LAI) regimen approved and could be a game-changer in the world of HIV treatment, as it is the first ever HIV drug combination that does not need to be taken every day. However, although data from randomized clinical trials demonstrated the non-inferiority efficacy of CAB/RPV LAI in PWH switching from triple therapies, a higher rate of emergent resistance associated mutations (RAMs) to INSTI and NNRTIs emerged. The risk of acquired RAMs may be even higher in clinical practice, outside the controlled conditions of clinical trials. Although the rate of virological failure is quite rare (1%-2%), resistance to these types of drugs (especially INSTI) is a major problem for PWH, as it severely limits the future treatment options. In the light of these considerations, it becomes important to understand if the reduced susceptibility is really relevant in clinical practice, identifying the remaining treatment options; are PIs the only possible choice or is there still room for INSTIs? In this sense, bictegravir has the longest dissociation time from the target among INSTIs (retaining its inhibitory activity against HIV replication for a longer time) and showed an improved resistance profile compared with other INSTIs, including DTG, in vitro. Moreover, a recent in vitro phenotype assessment of isolates with a CAB failure-like patterns of RAMs showed that 54% and 40% of the isolates maintained susceptibility or partial susceptibility to bictegravir, respectively.
Finally, it is currently unknown if INSTI mutations will persist on DNA or if they will disappear.
This study is a pilot, multi-center, observational retrospective-prospective study, that will include 30 subjects failing CAB/RPV LAI. The primary objective is to describe drug efficacy at week 24. Secondary objectives are to describe drug efficacy at week 48, to describe drug failure at week 24 and week 48, to describe immunological changes at week 24 and week 48, to describe drug safety and to describe changes in patient's quality of life.
Undersøgelsestype
Undersøgelsestype
Tilmelding (Anslået)
Tilmelding
Kontakter og lokationer
Studiekontakt
Studiekontakt
- Navn: Cristina Mussini, Full Professor, MD
- Telefonnummer: +390594222466
- E-mail: cristina.mussini@unimore.it
Studiesteder
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-
MO
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Modena, MO, Italien, 41124
- AOU Modena
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Kontakt:
- Cristina Mussini, MD
- Telefonnummer: +390594222466
- E-mail: cristina.mussini@unimore.it
-
-
Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
- Voksen
- Ældre voksen
Tager imod sunde frivillige
Prøveudtagningsmetode
Studiebefolkning
Beskrivelse
Inclusion Criteria:
- PWH with age >18 years
- PWH with a confirmed virological failure on CAB/RPV LAI in the last three years
- PWH without RAMs versus FTC and TAF
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
Antal grupper/kohorter
Kohorter og interventioner
Gruppe / kohorteGruppe / kohorte |
|---|
|
1
subjects failing CAB/RPV LAI switching to BIC/FTC/TAF per clinical practice
|
Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Tidsramme |
|---|---|
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Rate of virological suppression (proportion of PWH with HIV-RNA <50 copies/mL) at week 24 (after the switch to BIC/FTC/TAF)
Tidsramme: From enrollment to week 24
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From enrollment to week 24
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Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Tidsramme |
|---|---|
|
Rate of virological suppression (proportion of PWH with HIV-RNA <50 copies/mL) at week 48
Tidsramme: From enrollment to week 48
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From enrollment to week 48
|
|
Rate of virologic failure (2 consecutive VL ≥50 copies/mL) at weeks 24 and 48
Tidsramme: From enrollment to week 48
|
From enrollment to week 48
|
|
Change from baseline in CD4+ T-cell count (absolute and %) and CD4/CD8 ratio at weeks 24 and 48
Tidsramme: From enrollment to week 48
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From enrollment to week 48
|
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WHO grade 3-4 toxicity
Tidsramme: From enrollment to week 48
|
From enrollment to week 48
|
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Rate of discontinuation of BIC/FTC/TAF for AEs
Tidsramme: From enrollment to week 48
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From enrollment to week 48
|
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Change in treatment satisfaction after the switch to BIC/FTC/TAF (changes in HIVTSQ)
Tidsramme: From enrollment to week 48
|
From enrollment to week 48
|
Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Publikationer og nyttige links
Generelle publikationer
- Cutrell AG, Schapiro JM, Perno CF, Kuritzkes DR, Quercia R, Patel P, Polli JW, Dorey D, Wang Y, Wu S, Van Eygen V, Crauwels H, Ford SL, Baker M, Talarico CL, Clair MS, Jeffrey J, White CT, Vanveggel S, Vandermeulen K, Margolis DA, Aboud M, Spreen WR, van Lunzen J. Exploring predictors of HIV-1 virologic failure to long-acting cabotegravir and rilpivirine: a multivariable analysis. AIDS. 2021 Jul 15;35(9):1333-1342. doi: 10.1097/QAD.0000000000002883.
- Jongen VW, Wit FWNM, Boyd A, van Eeden A, Brouwer AE, Soetekouw R, El Moussaoui R, Stalenhoef J, Sigaloff KCE, Mudrikova T, Gisolf J, Burger D, Wensing AMJ, van der Valk M; ATHENA National Observational HIV Cohort. Effectiveness of bi-monthly long-acting injectable cabotegravir and rilpivirine as maintenance treatment for HIV-1 in the Netherlands: results from the Dutch ATHENA national observational cohort. Lancet HIV. 2025 Jan;12(1):e40-e50. doi: 10.1016/S2352-3018(24)00269-8.
- Iannone V, Lombardi F, Ciccullo A, Lamanna F, Salvo PF, Sanfilippo A, Baldin G, Borghetti A, Torti C, Di Giambenedetto S. Real World Data from an Italian Outpatient Clinical Setting and from Home Care Assistance of Treatment-Experienced PWH Switching to CAB + RPV Regimen: A Prospective Observational Study. AIDS Behav. 2025 Apr;29(4):1228-1234. doi: 10.1007/s10461-024-04597-4. Epub 2025 Jan 9.
- Mchantaf G, Chaillon A, Charre C, Melard A, Gardiennet E, Guinard J, Prazuck T, Guillaume C, Mariaggi AA, Bois J, Hocqueloux L, Avettand-Fenoel V. Learning From Full Characterization of HIV Proviruses in People Receiving Long-Acting Cabotegravir/Rilpivirine With a History of Replication on the Antiretroviral Classes. Open Forum Infect Dis. 2024 Dec 24;12(1):ofae748. doi: 10.1093/ofid/ofae748. eCollection 2025 Jan.
- McCall KL, Cabral DL, Coghlan JF, Concepcion AM, Denimarck KE, Shalumov SS. Therapeutic failure reported with HIV long-acting injectables: An analysis of the FDA Adverse Event Reporting System from 2021 to 2024. HIV Med. 2025 Jan;26(1):173-178. doi: 10.1111/hiv.13709. Epub 2024 Sep 5.
- Perez Navarro A, Nutt CT, Siedner MJ, McCluskey SM, Hill A. Virologic Failure and Emergent Integrase Strand Transfer Inhibitor Drug Resistance With Long-Acting Cabotegravir for HIV Treatment: A Meta-analysis. Clin Infect Dis. 2025 Sep 16;81(2):274-285. doi: 10.1093/cid/ciae631.
Datoer for undersøgelser
Studer store datoer
Studiestart (Anslået)
Studiestart
Primær færdiggørelse (Anslået)
Primær færdiggørelse
Studieafslutning (Anslået)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
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
- Blodbårne infektioner
- Urogenitale sygdomme
- Genitale sygdomme
- Sygdomme i immunsystemet
- Infektioner
- RNA-virusinfektioner
- Virussygdomme
- Overførbare sygdomme
- Seksuelt overførte sygdomme, virale
- Seksuelt overførte sygdomme
- Lentivirus infektioner
- Retroviridae infektioner
- Immunologiske mangelsyndromer
- HIV-infektioner
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- BICPREVIR
- 2573 (Registry Identifier: Registro Studi Osservazionali)
Plan for individuelle deltagerdata (IPD)
Planlægger du at dele individuelle deltagerdata (IPD)?
Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter
Studerer et amerikansk FDA-reguleret lægemiddelprodukt
Studerer et amerikansk FDA-reguleret enhedsprodukt
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