- ICH GCP
- Registro degli studi clinici negli Stati Uniti
- Sperimentazione clinica NCT00988039
Europe-Africa Research Network for Evaluation of Second-line Therapy (EARNEST)
A Randomised Controlled Trial to Evaluate Options for Second-line Therapy in Patients Failing a First-line 2NRTI + NNRTI Regimen in Africa
Panoramica dello studio
Stato
Condizioni
Intervento / Trattamento
Descrizione dettagliata
The standard of care for second-line HIV therapy in patients who have failed a first-line NNRTI-based regimen is to combine a boosted protease inhibitor (bPI) with two (new) NRTIs. However, patients failing first-line therapy in roll-out programmes often have extensive NRTI resistance mutations that may compromise the efficacy of the NRTI drugs used in second-line therapy and it is likely that the virological potency of the second-line regimen is mostly due to the bPI. It is possible that the contribution of the NRTI drugs to efficacy may be outweighed by additional toxicity and cost. It is also possible that replacing the NRTI drugs with a new class of drug (integrase inhibitors) will improve outcome from second-line therapy, although if the boosted protease inhibitor alone is providing close to optimal response, incremental gains from adding a new class may be small.
The principal aims are to determine whether, in patients failing a first-line NRTI and NNRTI-containing regimen:
- The use of bPI plus raltegravir (an integrase inhibitor) is superior to standard of care (bPI plus 2 new NRTIs) in achieving good HIV disease control at 96 weeks after randomisation
- The use of bPI monotherapy, preceded by a 12-week induction period in combination with raltegravir, is non-inferior to standard of care in achieving good HIV disease control at 96 weeks after randomisation
Tipo di studio
Iscrizione (Effettivo)
Fase
- Fase 3
Contatti e Sedi
Luoghi di studio
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Eldoret, Kenya
- AMPATH Centre at Moi Teaching Referral Hospital
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Blantyre, Malawi
- University of Malawi
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Mzuzu, Malawi
- Mzuzu Central Hospital
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Fort Portal, Uganda
- Joint Clinical Research Centre
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Gulu, Uganda
- JCRC
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Kabale, Uganda
- JCRC
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Kakira, Uganda
- JCRC
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Kampala, Uganda
- Infectious Diseases Institute
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Kampala, Uganda
- Joint Clinical Research Centre
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Kampala, Uganda
- San Raphael of St Francis Hospital Nsambya
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Mbale, Uganda
- Joint Clinical Research Centre
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Mbarara, Uganda
- Joint Clinical Research Centre
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Lusaka, Zambia
- University Teaching Hospital
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Harare, Zimbabwe
- University of Zimbabwe Clinical Research Centre
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Criteri di partecipazione
Criteri di ammissibilità
Età idonea allo studio
Accetta volontari sani
Sessi ammissibili allo studio
Descrizione
Inclusion Criteria:
- Previously documented HIV infection on at least one standard antibody-based test
- Age 12 years and above
- Taking 2NRTI + NNRTI-based regimen continuously for at least 12 months
- Naive to protease inhibitor therapy
- Good adherence to ART in the 12 weeks prior to screening defined as missing medication on no more than 3 days in the prior month
- Clinically stable and receiving treatment for any known opportunistic infections
- HIV treatment failure defined by one or more of clinical, immunological or virological criteria defined in the protocol, including VL and CD4 at screening visit
- Willing and able to give informed consent
- Able to attend for regular study follow up visits
Exclusion Criteria:
- Any major clinical contra-indications to the use of bPI, the NRTIs that are available to be selected for a second-line regimen or raltegravir
- Known Hepatitis B carrier (Hepatitis B surface antigen positive if tested)
- Requires concomitant medication with known major interactions with study drugs for which drug substitutions or dose alterations are not available or acceptable
- Women who are currently pregnant or breastfeeding
- Current participation in another clinical trial involving a treatment intervention (may be permitted in some circumstances, but must be discussed with MRC CTU)
- Life expectancy of less than one month in the opinion of the treating physician
Piano di studio
Come è strutturato lo studio?
Dettagli di progettazione
- Scopo principale: Trattamento
- Assegnazione: Randomizzato
- Modello interventistico: Assegnazione parallela
- Mascheramento: Nessuno (etichetta aperta)
Armi e interventi
Gruppo di partecipanti / Arm |
Intervento / Trattamento |
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Comparatore attivo: bPI + 2NRTIs
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Aluvia (lopinavir/ritonavir 400mg/100mg), twice daily The choice of NRTIs will be at the discretion of the managing clinician and based on the local standard of care and drug availability, taking into account patient's previous drug exposure and side effects on first-line therapy. |
Sperimentale: bPI + raltegravir
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Aluvia (lopinavir/ritonavir 400mg/100mg) twice daily raltegravir (400mg) twice daily |
Sperimentale: bPI monotherapy
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Aluvia (lopinavir/ritonavir 400mg/100mg) twice daily raltegravir (400mg) twice daily for the first 12 weeks only |
Cosa sta misurando lo studio?
Misure di risultato primarie
Misura del risultato |
Lasso di tempo |
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Good HIV disease control defined as a composite endpoint consisting of all of: - No new WHO stage 4 events - CD4 count >250 cells/mm3 - viral load <10,000 copies/ml or >10,000 copies/ml with no PI resistance mutations
Lasso di tempo: week 96
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week 96
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Misure di risultato secondarie
Misura del risultato |
Lasso di tempo |
---|---|
Good HIV disease control
Lasso di tempo: week 144
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week 144
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Proportion with CD4 cell count >250 cells/mm3
Lasso di tempo: week 96 and week 144
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week 96 and week 144
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Proportion with new or recurrent WHO stage 4 event
Lasso di tempo: week 96 and week 144
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week 96 and week 144
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Proportion of patients with plasma viral load <50 copies
Lasso di tempo: week 48, week 96 and week 144
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week 48, week 96 and week 144
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Adverse events
Lasso di tempo: During trial
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During trial
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Quality of life change from randomisation
Lasso di tempo: During trial
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During trial
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Neurocognitive function change from randomisation
Lasso di tempo: during trial
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during trial
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Healthcare costs
Lasso di tempo: During trial
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During trial
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Proportion with serious non-AIDS events
Lasso di tempo: Week 96 and week 144
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Week 96 and week 144
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Collaboratori e investigatori
Sponsor
Investigatori
- Direttore dello studio: Nicholas Paton, MD FRCP, MRC CTU
Pubblicazioni e link utili
Pubblicazioni generali
- Shi Y, Thompson J, Walker AS, Paton NI, Cheung YB; EARNEST Trial Team. Mapping the medical outcomes study HIV health survey (MOS-HIV) to the EuroQoL 5 Dimension (EQ-5D-3 L) utility index. Health Qual Life Outcomes. 2019 May 10;17(1):83. doi: 10.1186/s12955-019-1135-8.
- Thompson JA, Kityo C, Dunn D, Hoppe A, Ndashimye E, Hakim J, Kambugu A, van Oosterhout JJ, Arribas J, Mugyenyi P, Walker AS, Paton NI; Europe-Africa Research Network for Evaluation of Second-line Therapy (EARNEST) Trial Team. Evolution of Protease Inhibitor Resistance in Human Immunodeficiency Virus Type 1 Infected Patients Failing Protease Inhibitor Monotherapy as Second-line Therapy in Low-income Countries: An Observational Analysis Within the EARNEST Randomized Trial. Clin Infect Dis. 2019 Mar 19;68(7):1184-1192. doi: 10.1093/cid/ciy589.
- Paton NI, Kityo C, Thompson J, Nankya I, Bagenda L, Hoppe A, Hakim J, Kambugu A, van Oosterhout JJ, Kiconco M, Bertagnolio S, Easterbrook PJ, Mugyenyi P, Walker AS; Europe Africa Research Network for Evaluation of Second-line Therapy (EARNEST) Trial Team. Nucleoside reverse-transcriptase inhibitor cross-resistance and outcomes from second-line antiretroviral therapy in the public health approach: an observational analysis within the randomised, open-label, EARNEST trial. Lancet HIV. 2017 Aug;4(8):e341-e348. doi: 10.1016/S2352-3018(17)30065-6. Epub 2017 May 8.
- Paton NI, Kityo C, Hoppe A, Reid A, Kambugu A, Lugemwa A, van Oosterhout JJ, Kiconco M, Siika A, Mwebaze R, Abwola M, Abongomera G, Mweemba A, Alima H, Atwongyeire D, Nyirenda R, Boles J, Thompson J, Tumukunde D, Chidziva E, Mambule I, Arribas JR, Easterbrook PJ, Hakim J, Walker AS, Mugyenyi P; EARNEST Trial Team. Assessment of second-line antiretroviral regimens for HIV therapy in Africa. N Engl J Med. 2014 Jul 17;371(3):234-47. doi: 10.1056/NEJMoa1311274.
Collegamenti utili
Studiare le date dei record
Studia le date principali
Inizio studio
Completamento primario (Effettivo)
Completamento dello studio (Effettivo)
Date di iscrizione allo studio
Primo inviato
Primo inviato che soddisfa i criteri di controllo qualità
Primo Inserito (Stima)
Aggiornamenti dei record di studio
Ultimo aggiornamento pubblicato (Stima)
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo verificato
Maggiori informazioni
Termini relativi a questo studio
Parole chiave
Termini MeSH pertinenti aggiuntivi
- Infezioni da virus a RNA
- Malattie virali
- Infezioni
- Infezioni a trasmissione ematica
- Malattie trasmissibili
- Malattie sessualmente trasmissibili, virali
- Malattie trasmesse sessualmente
- Infezioni da lentivirus
- Infezioni da retroviridae
- Malattie del sistema immunitario
- Malattie da virus lenti
- Infezioni da HIV
- Sindrome da immunodeficienza acquisita
- Sindromi da deficit immunologico
- Meccanismi molecolari dell'azione farmacologica
- Agenti antinfettivi
- Agenti antivirali
- Inibitori enzimatici
- Agenti anti-HIV
- Agenti antiretrovirali
- Inibitori della proteasi
- Inibitori del citocromo P-450 CYP3A
- Inibitori dell'enzima del citocromo P-450
- Inibitori dell'integrasi dell'HIV
- Inibitori dell'integrasi
- Inibitori della proteasi dell'HIV
- Inibitori virali della proteasi
- Raltegravir Potassio
- Lopinavir
Altri numeri di identificazione dello studio
- U.1228.03.004.00021.01
- IP_2007_33011_003
- ISRCTN37737787
Informazioni su farmaci e dispositivi, documenti di studio
Studia un prodotto farmaceutico regolamentato dalla FDA degli Stati Uniti
Studia un dispositivo regolamentato dalla FDA degli Stati Uniti
prodotto fabbricato ed esportato dagli Stati Uniti
Queste informazioni sono state recuperate direttamente dal sito web clinicaltrials.gov senza alcuna modifica. In caso di richieste di modifica, rimozione o aggiornamento dei dettagli dello studio, contattare register@clinicaltrials.gov. Non appena verrà implementata una modifica su clinicaltrials.gov, questa verrà aggiornata automaticamente anche sul nostro sito web .
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