A Phase 3 interventional study of Dapivirine Vaginal Ring and Placebo Ring in HIV Infections, sponsored by International Partnership for Microbicides, Inc.. Completed at 7 sites in 4 countries. Open to female participants aged 18 Years to 45 Years, including healthy volunteers. Per ClinicalTrials.gov, last updated 2022-12-21.
Sponsored by International Partnership for Microbicides, Inc. · Phase 3, Interventional, and Prevention
This is a double-blind, randomised, placebo-controlled study to assess the safety and efficacy of a silicone elastomer vaginal matrix ring.
A Multi-Center, Randomized, Double-Blind, Placebo-Controlled Phase 3 Safety and Effectiveness Trial of a Vaginal Matrix Ring Containing Dapivirine for the Prevention of HIV-1 Infection in Women." MTN-020 will enroll approximately 3676 sexually active HIVnegative women aged 18-45 years randomized in a 1:1 ratio to receive either a vaginal ring containing 25 mg of dapivirine or a placebo vaginal ring. Rings will be inserted once every 28 days for 12 consecutive months. MTN expects to initiate this study in August 2012.
Exclusion Criteria:
Per participant report at screening:
Is pregnant
-- Note: A documented negative pregnancy test performed by study staff is required for inclusion; however a self-reported pregnancy is adequate for exclusion from the study.
Diagnosed with urinary tract infection (UTI)
-- Note: Otherwise eligible participants diagnosed with UTI during screening are offered treatment and may be enrolled after completing treatment and all symptoms have resolved. If treatment is completed and symptoms have resolved within 28 days of obtaining informed consent for screening, the participant may be enrolled.
Diagnosed with pelvic inflammatory disease, an STI or reproductive tract infection (RTI) requiring treatment per current WHO guidelines
-- Note: Otherwise eligible participants diagnosed during screening with pelvic inflammatory disease or STI/RTI requiring treatment per WHO guidelines - other than asymptomatic BV and asymptomatic candidiasis - are offered treatment and may be enrolled after completing treatment and all symptoms have resolved. If treatment is completed and symptoms have resolved within 28 days of obtaining informed consent for screening, the participant may be enrolled. Genital warts requiring treatment also must be treated prior to enrollment. Genital warts requiring therapy are defined as those that cause undue burden or discomfort to the participant, including bulky size, unacceptable appearance, or physical discomfort.
Has a clinically apparent Grade 2 or higher pelvic exam finding (observed by study staff) as per the Division of AIDS Table for Grading the Severity of Adult and Pediatric Adverse Events Version 1.0, December, 2004 (Clarification dated August 2009), Addendum 1-Female Genital Grading Table for Use in Microbicide Studies
Participant report and/or clinical evidence of any of the following:
Has any of the following laboratory abnormalities at Screening Visit:
Pap result Grade 2 or higher according to the Female Genital Grading Table for Use in Microbicide Studies Addendum 1 to the DAIDS Table for Grading Adult and Pediatric Adverse Events, Version 1.0, December 2004 (Clarification dated August 2009)
Vaginal ring containing 25mg dapivirine
Combination Product: Dapivirine Vaginal Ring
Vaginal ring containing no drug substance
Combination Product: Placebo Ring
Dosage form: vaginal ring Dosage: 25mg Frequency: monthly Duration: 12 months
Vaginal ring containing no drug substance
Efficacy as Determined by the Proportion of Women in Each Arm With HIV-1 Seroconversion After 120 Endpoints Are Observed in the Trial.
The primary endpoint is HIV-1 seroconversion as measured by rapid and specialised laboratory testing according to comprehensive HIV testing algorithm. Endpoint confirmation of HIV infection is by Western Blot.
Time frame: minimum of 12 months and a maximum of 14 months per participant
The Number of Participants That Experienced Grade 2, 3, 4 and Serious Adverse Events Over the Investigational Product Used Period (25 mg Dapivirine Administered in a Silicone Elastomer Vaginal Matrix Ring (DVR), Inserted Once Every 4 Weeks).
Participants with grade 2 adverse events, judged to be related to investigational product, grade 3 and grade 4 adverse events and all serious adverse events. DAIDS severity grades are defined as follows: Grade 1 = mild Grade 2 = moderate Grade 3 = severe Grade 4 = potentially life-threatening Grade 5 = death
Time frame: minimum of 12 months and a maximum of 14 months per participant
Adherence to the Dapivirine Vaginal Ring.
Dapivirine residual levels in used rings and dapivirine plasma concentrations are two objective measures of adherence to DVR ring use. Adherence was defined as a dapivirine ring residual level \<=23.5 mg and dapivirine plasma level \>= 95 pg/mL.
Time frame: 12 months per participant
Acceptability of the DVR and Placebo Vaginal Ring
Questionnaires and qualitative data regarding the acceptability of use of a vaginal ring inserted once every 4 weeks over the trial period; Percentage of participants with positive response. Response of 'likely' or 'very likely' to the question: 'If in the future a vaginal ring was available that provided some protection against HIV, and it was similar to the one you used in this trial, how likely would you be to keep it inserted in your vagina every day?'
Time frame: 12 months per participant
Human Immunodeficiency Virus Type 1 Drug Resistance Mutations Among Participants Who Acquired HIV-1 Infection.
The analysis of HIV-1 drug resistance will be primarily descriptive in nature, and will depend on the pattern of resistance mutations observed in the HIV-1 seroconverters. The percentage of HIV-1 seroconverters with at least one HIV-1 drug resistant mutation will be presented overall, and by treatment arm, with corresponding 95% CIs.
Time frame: minimum of 12 months and a maximum of 14 months per participant
Participants provided written informed consent were invited to screen for the clinical trial. Each participant engaged in the screening process for up to 4 weeks (28 days) prior to enrollment. Participants who complied with inclusion and exclusion criteria were invited to enroll in the trial. Participants were randomized in a 1:1 ratio to either the Dapivirine Vaginal Ring or placebo ring group.
| Milestone | Dapivirine Vaginal Ring | Placebo Ring |
|---|---|---|
| Started | 1313 | 1316 |
| Completed | 1165 | 1179 |
| Not completed | 148 | 137 |
| Withdrew: Withdrawal by subject | 96 | 81 |
| Withdrew: Lost to follow-up | 37 | 32 |
| Withdrew: Physician decision | 10 | 18 |
| Withdrew: Death | 4 | 3 |
| Withdrew: Other | 1 | 3 |
The primary endpoint is HIV-1 seroconversion as measured by rapid and specialised laboratory testing according to comprehensive HIV testing algorithm. Endpoint confirmation of HIV infection is by Western Blot.
| Participants | Dapivirine Vaginal Ring | Placebo Ring |
|---|---|---|
| Efficacy as Determined by the Proportion of Women in Each Arm With HIV-1 Seroconversion After 120 Endpoints Are Observed in the Trial. | 71 | 97 |
Participants with grade 2 adverse events, judged to be related to investigational product, grade 3 and grade 4 adverse events and all serious adverse events. DAIDS severity grades are defined as follows: Grade 1 = mild Grade 2 = moderate Grade 3 = severe Grade 4 = potentially life-threatening Grade 5 = death
| Participants | Dapivirine Vaginal Ring | Placebo Ring |
|---|---|---|
| The Number of Participants That Experienced Grade 2, 3, 4 and Serious Adverse Events Over the Investigational Product Used Period (25 mg Dapivirine Administered in a Silicone Elastomer Vaginal Matrix Ring (DVR), Inserted Once Every 4 Weeks). | 1237 | 1231 |
Dapivirine residual levels in used rings and dapivirine plasma concentrations are two objective measures of adherence to DVR ring use. Adherence was defined as a dapivirine ring residual level \<=23.5 mg and dapivirine plasma level \>= 95 pg/mL.
| participants with data | Dapivirine Vaginal Ring |
|---|---|
| Month 1 | 443 |
| Month 2 | 460 |
| Month 3 | 953 |
| Month 4 | 537 |
| Month 5 | 573 |
| Month 6 | 963 |
| Month 7 | 687 |
| Month 8 | 699 |
| Month 9 | 943 |
| Month 10 | 830 |
| Month 11 | 916 |
| Month 12 | 922 |
| Month 13 | 872 |
| Month 14 | 858 |
| Month 15 | 793 |
| Month 16 | 704 |
| Month 17 | 701 |
| Month 18 | 675 |
| Month 19 | 600 |
| Month 20 | 598 |
| Month 21 | 576 |
| Month 22 | 499 |
| Month 23 | 485 |
| Month 24 | 471 |
| Month 25 | 391 |
| Month 26 | 384 |
| Month 27 | 367 |
| Month 28 | 263 |
| Month 29 | 258 |
| Month 30 | 251 |
| Month 31 | 133 |
| Month 32 | 130 |
| Month 33 | 120 |
| Month 34 | 4 |
Questionnaires and qualitative data regarding the acceptability of use of a vaginal ring inserted once every 4 weeks over the trial period; Percentage of participants with positive response. Response of 'likely' or 'very likely' to the question: 'If in the future a vaginal ring was available that provided some protection against HIV, and it was similar to the one you used in this trial, how likely would you be to keep it inserted in your vagina every day?'
| percentage of participants with data | Dapivirine Vaginal Ring | Placebo Ring |
|---|---|---|
| Acceptability of the DVR and Placebo Vaginal Ring | 95.9 | 96.8 |
The analysis of HIV-1 drug resistance will be primarily descriptive in nature, and will depend on the pattern of resistance mutations observed in the HIV-1 seroconverters. The percentage of HIV-1 seroconverters with at least one HIV-1 drug resistant mutation will be presented overall, and by treatment arm, with corresponding 95% CIs.
| Participants | Dapivirine Vaginal Ring | Placebo Ring |
|---|---|---|
| Human Immunodeficiency Virus Type 1 Drug Resistance Mutations Among Participants Who Acquired HIV-1 Infection. | 68 | 96 |
Collected over 24 Months. Non-serious events are listed at a 2% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Dapivirine Vaginal Ring | 4/1,313 (0.3%) | 116/1,313 (8.8%) | 1,237/1,313 (94.2%) |
| Placebo Ring | 3/1,316 (0.2%) | 130/1,316 (9.9%) | 1,041/1,316 (79.1%) |
| Event | Dapivirine Vaginal Ring | Placebo Ring |
|---|---|---|
| Vaginal DischargeReproductive system and breast disorders | 17/1313 | 20/1316 |
| Pelvic PainReproductive system and breast disorders | 15/1313 | 20/1316 |
| MetrorrhagiaReproductive system and breast disorders | 16/1313 | 9/1316 |
| Vulvovaginal PruritusReproductive system and breast disorders | 10/1313 | 12/1316 |
| Vulvovaginal discomfortReproductive system and breast disorders | 9/1313 | 5/1316 |
| Aspartate aminotransferase increasedInvestigations | 4/1313 | 9/1316 |
| Vaginal odourReproductive system and breast disorders | 3/1313 | 8/1316 |
| Alanine aminotransferase increasedInvestigations | 3/1313 | 7/1316 |
| Cervix erythemaReproductive system and breast disorders | 6/1313 | 5/1316 |
| Neutrophil count decreasedInvestigations | 4/1313 | 6/1316 |
| Event | Dapivirine Vaginal Ring | Placebo Ring |
|---|---|---|
| MetrorrhagiaReproductive system and breast disorders | 723/1313 | 732/1316 |
| Urinary tract infectionInfections and infestations | 223/1313 | 281/1316 |
| Genitourinary chlamydia infectionInfections and infestations | 269/1313 | 274/1316 |
| MenorrhagiaReproductive system and breast disorders | 259/1313 | 242/1316 |
| Vaginal dischargeReproductive system and breast disorders | 179/1313 | 174/1316 |
| Abnormal loss of weightMetabolism and nutrition disorders | 173/1313 | 175/1316 |
| Bacterial vaginosisInfections and infestations | 168/1313 | 157/1316 |
| MenometrorrhagiaReproductive system and breast disorders | 160/1313 | 148/1316 |
| Genitourinary tract gonococcal infectionInfections and infestations | 143/1313 | 160/1316 |
| Alanine aminotransferase increasedInvestigations | 147/1313 | 160/1316 |
Primary safety cohort
| Age, Continuous(years) | Dapivirine Vaginal Ring | Placebo Ring | Total |
|---|---|---|---|
| Mean | 27.2 ± 6.09 | 27.3 ± 6.28 | 27.2 ± 6.18 |
| Sex: Female, Male(Participants) | Dapivirine Vaginal Ring | Placebo Ring | Total |
|---|---|---|---|
| Female | 1313 | 1316 | 2629 |
| Male | 0 | 0 | 0 |
| Race (NIH/OMB)(Participants) | Dapivirine Vaginal Ring | Placebo Ring | Total |
|---|---|---|---|
| American Indian or Alaska Native | 0 | 0 | 0 |
| Asian | 13 | 3 | 16 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 |
| Black or African American | 1228 | 1226 | 2454 |
| White | 2 | 0 | 2 |
| More than one race | 0 | 0 | 0 |
| Unknown or Not Reported | 70 | 87 | 157 |
| Region of Enrollment(Participants) | Dapivirine Vaginal Ring | Placebo Ring | Total |
|---|---|---|---|
| South Africa | 713 | 713 | 1426 |
| Zimbabwe | 338 | 340 | 678 |
| Malawi | 135 | 137 | 272 |
| Uganda | 127 | 126 | 253 |
| BMI(kg/(m^2)) | Dapivirine Vaginal Ring | Placebo Ring | Total |
|---|---|---|---|
| Mean | 26.8 ± 6.41 | 27.2 ± 6.93 | 27.0 ± 6.68 |
| Education Status(Participants) | Dapivirine Vaginal Ring | Placebo Ring | Total |
|---|---|---|---|
| Less than Secondary School | 212 | 192 | 404 |
| Secondary School and Higher | 1101 | 1124 | 2225 |
| Marital Status(Participants) | Dapivirine Vaginal Ring | Placebo Ring | Total |
|---|---|---|---|
| Married | 527 | 547 | 1074 |
| Non-Married | 786 | 767 | 1553 |
| Missing | 0 | 2 | 2 |
| Has children(Participants) | Dapivirine Vaginal Ring | Placebo Ring | Total |
|---|---|---|---|
| Count of participants | 1188 | 1177 | 2365 |
4 further baseline measures are reported on the registry.
Plan to share: No
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International Partnership for Microbicides, Inc.