A Phase 3 interventional study of Darunavir and Ritonavir in Human Immunodeficiency Virus (HIV) Infections and Acquired Immunodeficiency Syndrome (AIDS) Virus, sponsored by Janssen-Cilag International NV. Completed at 36 sites in 13 countries. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2017-11-27.
Sponsored by Janssen-Cilag International NV · Phase 3, Interventional, and Treatment
The purpose of this study is to compare the efficacy, safety and tolerability of darunavir/ritonavir 800/100 mg monotherapy with a triple combination therapy containing darunavir/ritonavir 800/100 mg and 2 nucleoside/nucleotide reverse transcriptase inhibitors (N[t]RTIs) in approximately 260 Human Immunodeficiency Virus-1 (HIV-1) infected patients who have been on Highly Active AntiRetroviral Therapy (HAART) medication and have a plasma Viral Load below 50 copies/mL for at least 48 weeks. Also the changes in neurocognitive function will be compared throughout the study.
This is phase IIIb, randomised (study medication is assigned by chance), open-label (both the patient and the study physician will know to which treatment group the patient is assigned) trial to compare the efficacy, safety and tolerability of darunavir/ritonavir (DRV/rtv) 800/100 mg once daily monotherapy with a triple combination therapy containing DRV/rtv 800/100 mg once daily and an investigator-selected background of 2 other anti-HIV drugs of the class nucleoside/nucleotide reverse transcriptase inhibitors (N[t]RTIs). The investigator-selected N[t]RTIs is a dual combination of either be abacavir (ABC), lamivudine (3TC), zidovudine (AZT), tenofovir disoproxil fumarate (TDF) or emtricitabine (FTC). Approximately 260 HIV-1 infected patients, who have received HAART for at least 48 weeks, have not changed their treatment within the last 8 weeks, and who have documented evidence of plasma viral load (plasma HIV-1 RNA) below 50 copies/mL for at least 48 weeks prior to being screened, participate in the study. The study period includes a screening period of maximum 6 weeks, a 4-week run-in period, a 96 week treatment period, followed by a 4 weeks follow-up period. According to the original protocol, at the start of the 4-week run-in period all patients replaced their 3rd agent (non-nucleoside reverse transcriptase (NNRTI), protease inhibitor (PI) or integrase inhibitor) of the HAART medication with DRV/rtv and continued with the 2 N[t]RTIs. After 4 weeks the patient was randomly assigned (like flipping a coin) to either the monotherapy group or the triple therapy group. If assigned to the monotherapy group, the 2 N[t]RTIs were stopped and only DRV/rtv was continued. If assigned to the triple therapy group, DRV/rtv were continued together with 2 N[t]RTIs, which can be the same as already taken or are switched to new N[t]RTIs. Based on the primary efficacy analysis after Week 48, the protocol was amended such that subjects in the monotherapy arm who entered the study with a nadir CD4+ count of \<200 cells/μL will also receive 2 N[t]RTIs (ie, triple therapy) as soon as possible.
The main purpose of this study is to demonstrate that DRV/rtv monotherapy is as effective as a triple combination therapy containing DRV/rtv and 2N[t]RTIs. In addition, the study looks at overall safety and tolerability between the two treatment groups. During the study, patients' health are monitored by physical examination, checking of vital signs (blood pressure / pulse), and laboratory testing on blood and urine samples. Also blood samples are drawn to measure the antiviral effectiveness (i.e., decrease of the plasma viral load to a level \<50 HIV-1 RNA copies/mL) and immunology assessments (to assess the body's immune system). A battery of neurocognitive function tests is performed during the study visits. A sub-study takes place in selected hospitals. Approximately 100 patients have 2 additional tests done, at the start of the run-in phase and after 48-weeks of randomisation. For this substudy a lumbar puncture (extraction of cerebrospinal fluid [CSF] from the spinal canal) for laboratory testing (antiviral effectiveness, pharmacokinetic analysis, biochemistry and immune markers) and an additional blood sample for pharmacokinetic analysis (to measure the drug level in blood) is taken. The study hypothesis is that, after 48 weeks of randomised treatment, DRV/rtv monotherapy is as effective as the triple therapy containing DRV/rtv plus 2 N[t]RTIs. Two 400 mg tablets of darunavir and one 100 mg tablet ritonavir are taken together once daily orally within 30 minutes after completion of a meal, for 100 weeks. The intake of the investigator-selected N[t]RTIs as according the local prescribing information.
2,040 studies on the registry are indexed under Acquired Immunodeficiency Syndrome; 272 are open to participants now.
This study's enrollment of 274 is above the median of 105 across 1,543 interventional studies indexed under Acquired Immunodeficiency Syndrome.
Browse Acquired Immunodeficiency Syndrome studies →Janssen-Cilag International NV is the lead sponsor of 66 studies on the registry; none are open to participants now.
Counted across the registry records on this site, refreshed daily.
Exclusion Criteria:
Darunavir (DRV) + ritonavir (rtv): 2 tablets DRV 400 mg should be taken together with 1 tablet rtv 100 mg within 30 minutes after a meal. Following the primary efficacy analysis after Week 48, patients who entered the study with a nadir CD4+ count of \<200 cells/μL will also receive 2 N\[t\]RTIs (ie, triple therapy) as soon as possible
Drug: Darunavir · Drug: Ritonavir
Darunavir (DRV) + ritonavir (rtv) + 2 N\[t\]RTIs: 2 tablets DRV 400 mg should be taken together with 1 tablet rtv 100 mg within 30 minutes after a meal in combination with 2 N\[t\]RTIs (an investigator-selected dual combination of either abacavir (ABC), lamivudine (3TC), zidovudine (AZT), tenofovir disoproxil fumarate (TDF) or emtricitabine (FTC)
Drug: Darunavir · Drug: Ritonavir
Darunavir (DRV): type = exact number, unit = mg, number = 800, form = tablet, route = oral use
ritonavir (rtv): type = exact number, unit = mg, number = 100, form = tablet, route = oral use
Virologic Response (Food Drug and Administration [FDA] Snapshot, Switch = Failure)
The percentage of participants who have plasma human immunodeficiency virus type-1 (HIV-1) ribonucleic acid (RNA) levels \<50 copies/milliliters \[mL\] after 48 weeks of follow-up. Switch = Failure is defined as switch in background nucleoside/nucleotide reverse transcriptase inhibitors (N\[t\]RTIs) not permitted by the trial protocol or plasma HIV-1 RNA assessment closest to target date of the analysis time point window (44-52 weeks) and next/confirmation of Plasma HIV-1 RNA in the analysis time point window above the threshold or discontinuation for any other reason.
Time frame: Week 48
Virologic Response (Food Drug and Administration [FDA] Snapshot, Switch = Failure)
The percentage of participants who have plasma human immunodeficiency virus type-1 (HIV-1) ribonucleic acid (RNA) levels \<50 copies/milliliters \[mL\] after 96 weeks of follow-up after switching to DRV/ritonavir(rtv) monotherapy versus triple therapy containing DRV/rtv. Switch = Failure is defined as switch in background nucleoside/nucleotide reverse transcriptase inhibitors (N\[t\]RTIs) not permitted by the trial protocol.
Time frame: Week 96
Virologic Response (FDA Snapshot, Switch Included)
The percentage of participants who have plasma human immunodeficiency virus type-1 (HIV-1) ribonucleic acid (RNA) levels \<50 copies/milliliters \[mL\] after 48 and 96 weeks of follow-up after switching to DRV/ritonavir(rtv) monotherapy versus triple therapy containing DRV/rtv. Switch included is defined as all participants who discontinued randomized medication were followed up on their subsequent treatment.
Time frame: Week 48 and 96
Change From Baseline in Global Neurocognitive Performance z-Score
Change in neurocognitive function of DRV/rtv monotherapy versus triple therapy containing DRV/rtv over 48 and 96 weeks. Neurocognitive function will be measured by Hopkins Verbal Learning Test (verbal learning and memory), Colour Trail Test (psychomotor speed and cognitive flexibility) and Grooved Pegboard Test (psychomotor speed and fine motor function). Higher values for change in z-score represent an improvement in Neurocognitive Performance (NP).
Time frame: Baseline, Week 48 and 96
Time to Loss of Virologic Response
Time (in days) it takes to show loss of response per time to loss of virologic response (TLOVR) algorithm: confirmed HIV-1 RNA \>= 50 copies/mL or premature discontinuation.
Time frame: Baseline up to Week 96 or early withdrawal
Number of Participants Reporting Treatment-Emergent Phenotypic Drug Resistance
The loss of treatment options of DRV/rtv monotherapy versus triple therapy containing DRV/rtv at Weeks 48 and 96, as defined by treatment-emergent phenotypic drug resistance. Drug resistance is classified as: 1) Confirmed HIV RNA \>= 400 copies/mL, 2) Post-baseline phenotypic data and 3) Phenotypic resistance to any of the drug classes (NRTI, NNRTI, or PI).
Time frame: At Weeks 48 and 96
Number of Participants Reporting Resistance Mutations With Confirmed Virologic Failure Who Have HIV RNA >400 Copies/mL and Genotype Resistance Results
The viral genotype of participants treated with DRV/rtv monotherapy versus triple therapy containing DRV/rtv over 48 and 96 weeks. Genotypic resistance (number of resistance mutations) at any time point when a participant had a confirmed plasma VL \>400 copies/mL after randomization was performed per treatment group for the ITT population. Results were summarized based on individual treatment received: Darunavir resistance mutations, non-nucleoside reverse transcriptase inhibitor (NNRTI) mutations, nucleoside reverse transcriptase inhibitor (NRTI) mutations, protease inhibitor (PI) resistance mutations, PR mutations, RT mutations, extended NNRTI mutations, primary PI mutations.
Time frame: Over 48 and 96 Weeks
| Milestone | DRV/Rtv MONO | DRV/Rtv + 2NRTIs |
|---|---|---|
| Started | 137 | 136 |
| Completed | 119 | 118 |
| Not completed | 18 | 18 |
| Withdrew: Adverse event | 3 | 1 |
| Withdrew: Lost to follow-up | 2 | 6 |
| Withdrew: Withdrawal by subject | 6 | 7 |
| Withdrew: Other | 7 | 4 |
The percentage of participants who have plasma human immunodeficiency virus type-1 (HIV-1) ribonucleic acid (RNA) levels \<50 copies/milliliters \[mL\] after 48 weeks of follow-up. Switch = Failure is defined as switch in background nucleoside/nucleotide reverse transcriptase inhibitors (N\[t\]RTIs) not permitted by the trial protocol or plasma HIV-1 RNA assessment closest to target date of the analysis time point window (44-52 weeks) and next/confirmation of Plasma HIV-1 RNA in the analysis time point window above the threshold or discontinuation for any other reason.
| Percentage of Participants | DRV/r | DRV/r + 2NRTIs |
|---|---|---|
| Virologic Response (Food Drug and Administration [FDA] Snapshot, Switch = Failure) | 87.0 | 95.0 |
The percentage of participants who have plasma human immunodeficiency virus type-1 (HIV-1) ribonucleic acid (RNA) levels \<50 copies/milliliters \[mL\] after 96 weeks of follow-up after switching to DRV/ritonavir(rtv) monotherapy versus triple therapy containing DRV/rtv. Switch = Failure is defined as switch in background nucleoside/nucleotide reverse transcriptase inhibitors (N\[t\]RTIs) not permitted by the trial protocol.
| Percentage of Participants | DRV/r | DRV/r + 2NRTIs |
|---|---|---|
| Virologic Response (Food Drug and Administration [FDA] Snapshot, Switch = Failure) | 75.2 | 85.3 |
The percentage of participants who have plasma human immunodeficiency virus type-1 (HIV-1) ribonucleic acid (RNA) levels \<50 copies/milliliters \[mL\] after 48 and 96 weeks of follow-up after switching to DRV/ritonavir(rtv) monotherapy versus triple therapy containing DRV/rtv. Switch included is defined as all participants who discontinued randomized medication were followed up on their subsequent treatment.
| Percentage of Participants | DRV/r | DRV/r + 2NRTIs |
|---|---|---|
| Week 48 | 93.0 | 96.5 |
| Week 96 | 89.3 | 89.9 |
Change in neurocognitive function of DRV/rtv monotherapy versus triple therapy containing DRV/rtv over 48 and 96 weeks. Neurocognitive function will be measured by Hopkins Verbal Learning Test (verbal learning and memory), Colour Trail Test (psychomotor speed and cognitive flexibility) and Grooved Pegboard Test (psychomotor speed and fine motor function). Higher values for change in z-score represent an improvement in Neurocognitive Performance (NP).
| Units on a Scale | DRV/r | DRV/r + 2NRTIs |
|---|---|---|
| Change at Week 48 | 0.39 ± 0.048 | 0.42 ± 0.057 |
| Change at Week 96 | 0.63 ± 0.060 | 0.57 ± 0.057 |
Time (in days) it takes to show loss of response per time to loss of virologic response (TLOVR) algorithm: confirmed HIV-1 RNA \>= 50 copies/mL or premature discontinuation.
| Days | DRV/r | DRV/r + 2NRTIs |
|---|---|---|
| Time to Loss of Virologic Response | NA ± 19.92 | NA ± 18.88 |
The loss of treatment options of DRV/rtv monotherapy versus triple therapy containing DRV/rtv at Weeks 48 and 96, as defined by treatment-emergent phenotypic drug resistance. Drug resistance is classified as: 1) Confirmed HIV RNA \>= 400 copies/mL, 2) Post-baseline phenotypic data and 3) Phenotypic resistance to any of the drug classes (NRTI, NNRTI, or PI).
| Participants | DRV/r | DRV/r + 2NRTIs |
|---|---|---|
| Confirmed HIV RNA >= 400 copies/mL | 1 | 2 |
| Post-baseline phenotypic data | 2 | 1 |
| Phenotypic resistance to any of the drug classes | 0 | 0 |
The viral genotype of participants treated with DRV/rtv monotherapy versus triple therapy containing DRV/rtv over 48 and 96 weeks. Genotypic resistance (number of resistance mutations) at any time point when a participant had a confirmed plasma VL \>400 copies/mL after randomization was performed per treatment group for the ITT population. Results were summarized based on individual treatment received: Darunavir resistance mutations, non-nucleoside reverse transcriptase inhibitor (NNRTI) mutations, nucleoside reverse transcriptase inhibitor (NRTI) mutations, protease inhibitor (PI) resistance mutations, PR mutations, RT mutations, extended NNRTI mutations, primary PI mutations.
| Participants | DRV/r | DRV/r + 2NRTIs |
|---|---|---|
| Participans with HIV RNA >= 400 copies/mL | 1 | 2 |
| Number of 0 Darunavir resistance mutations | 2 | 1 |
| Number of 0 NNRTI mutations | 2 | 0 |
| Number of 1 NNRTI mutations | 0 | 1 |
| Number of 1 PI resistance mutations | 1 | 0 |
| Number of 5 PI resistance mutations | 0 | 1 |
| Number of 6 PI resistance mutations | 1 | 0 |
| Number of 11 PR mutations | 0 | 1 |
| Number of 15 PR mutations | 1 | 0 |
| Number of 7 PR mutations | 1 | 0 |
| Number of 14 RT mutations | 1 | 0 |
| Number of 16 RT mutations | 0 | 1 |
| Number of 33 RT mutations | 1 | 0 |
| Number of extended 0 NNRTI mutations | 2 | 0 |
| Number of extended 1 NNRTI mutations | 0 | 1 |
| Number of primary 0 PI mutations | 2 | 1 |
| Number of participants with no mutations | 0 | 0 |
Collected over Baseline up to 96 weeks. Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| DRV/Rtv MONO | — | 18/137 (13.1%) | 61/137 (44.5%) |
| DRV/Rtv + 2NRTIs | — | 14/136 (10.3%) | 47/136 (34.6%) |
| Event | DRV/Rtv MONO | DRV/Rtv + 2NRTIs |
|---|---|---|
| Hepatitis CInfections and infestations | 2/137 | 0/136 |
| PyrexiaGeneral disorders | 1/137 | 1/136 |
| TendernessGeneral disorders | 0/137 | 1/136 |
| HypersensitivityImmune system disorders | 0/137 | 1/136 |
| AbscessInfections and infestations | 0/137 | 1/136 |
| CellulitisInfections and infestations | 0/137 | 1/136 |
| Gastroenteritis ViralInfections and infestations | 0/137 | 1/136 |
| Groin AbscessInfections and infestations | 0/137 | 1/136 |
| MeningitisInfections and infestations | 0/137 | 1/136 |
| PyelonephritisInfections and infestations | 0/137 | 1/136 |
| Event | DRV/Rtv MONO | DRV/Rtv + 2NRTIs |
|---|---|---|
| DiarrhoeaGastrointestinal disorders | 18/137 | 10/136 |
| NasopharyngitisInfections and infestations | 16/137 | 11/136 |
| Back PainMusculoskeletal and connective tissue disorders | 10/137 | 4/136 |
| HeadacheNervous system disorders | 8/137 | 9/136 |
| CoughRespiratory, thoracic and mediastinal disorders | 8/137 | 8/136 |
| FatigueGeneral disorders | 7/137 | 7/136 |
| PyrexiaGeneral disorders | 4/137 | 7/136 |
| ArthralgiaMusculoskeletal and connective tissue disorders | 7/137 | 7/136 |
| DepressionPsychiatric disorders | 4/137 | 7/136 |
| HypercholesterolaemiaMetabolism and nutrition disorders | 7/137 | 0/136 |
Baseline characteristics were analyzed for all participants who were treated.
| Age, Continuous(years) | DRV/Rtv MONO | DRV/Rtv + 2NRTIs | Total |
|---|---|---|---|
| Mean | 44.6 ± 11.21 | 43.1 ± 10.41 | 43.9 ± 10.82 |
| Sex: Female, Male(Participants) | DRV/Rtv MONO | DRV/Rtv + 2NRTIs | Total |
|---|---|---|---|
| Female | 26 | 21 | 47 |
| Male | 111 | 115 | 226 |
| Region of Enrollment(participants) | DRV/Rtv MONO | DRV/Rtv + 2NRTIs | Total |
|---|---|---|---|
| AUSTRIA | 5 | 5 | 10 |
| BELGIUM | 7 | 8 | 15 |
| DENMARK | 8 | 7 | 15 |
| FRANCE | 16 | 12 | 28 |
| GERMANY | 11 | 11 | 22 |
| HUNGARY | 5 | 3 | 8 |
| IRELAND | 3 | 5 | 8 |
| ISRAEL | 5 | 5 | 10 |
| ITALY | 22 | 24 | 46 |
| POLAND | 7 | 6 | 13 |
| SPAIN | 17 | 23 | 40 |
| SWEDEN | 3 | 4 | 7 |
| SWITZERLAND | 10 | 5 | 15 |
| UNITED KINGDOM | 18 | 18 | 36 |
This study is completed, as verified in Oct 2017. You cannot join it, but the record below documents what was studied.
Get an email when the registry record changes — status, dates, results — or when someone posts here.
Sign in to followQuestions and observations about this study, from anyone following it. Not medical advice, and not a channel to the study team — their contact details are on the registry record.
Sign in to join the discussion. Reading takes no account; posting does. You choose a display name, and a pseudonym is the default.
Nothing here yet. If you are running this trial, taking part in it, or weighing whether to, this is the place to say so.
Acquired Immunodeficiency Syndrome→
Janssen-Cilag International NV