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Completed

NCT Number: NCT04295772

Doravirine/Islatravir (DOR/ISL) in Pediatric Participants With Human Immunodeficiency Virus Type 1 (HIV-1) Who Are <18 Years of Age and Weigh ≥35 kg (MK-8591A-028)

This is a phase 2, single-group, multi-site, open-label study of an islatravir/doravirine (ISL/DOR, MK-8591A) fixed dose combination (FDC) for the treatment of human immunodeficiency virus type 1 (HIV-1) infection in pediatric participants who are virologically suppressed (VS) on antiretroviral therapy (ART) for ≥3 months or are treatment-naive (TN). The primary purposes of the study are 1) to examine the steady-state pharmacokinetics (PK) of ISL in plasma; 2) the steady-state PK of ISL-triphosphate (ISL-TP) in peripheral blood mononuclear cells (PBMCs); and 3) to examine the safety and tolerability of ISL/DOR.

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Key information

Conditions

Age range

Up to 17 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Phase 2

Primary location

Azienda Ospedaliera Luigi Sacco ( Site 1300), Milan, Italy

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About this study

As of protocol amendment 03 (approved 08-Feb-2022), all participants have been discontinued from study therapy and will be switched to non-study antiretroviral therapy and monitored for safety. The present results cover data obtained through the cut-off date of 30-Mar-2022, and will be updated once monitoring is completed.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Is HIV-1 positive, is <18 years of age, and weighs ≥35 kg at screening.
  • VS Participants: Is HIV-1 positive at Screening with plasma HIV-1 RNA <50 copies/mL and has been receiving continuous, stable oral 2-drug or 3-drug combination ART ± PK booster with documented viral suppression for ≥3 months prior to providing documented informed consent/assent and has no history of prior virologic treatment failure on any past or current regimen.
  • TN Participants: Is HIV-1 positive at Screening with plasma HIV-1 RNA ≥500 copies/mL and is naive to ART defined as having received <=10 days of prior therapy with any antiretrovirals following HIV-1 diagnosis other than pre-exposure prophylaxis (PrEP) or potentially exposed person (PEP).
  • If female, is not pregnant or breastfeeding, and is either 1) not a woman of childbearing potential (WOCBP) or 2) is a WOCBP and is using acceptable contraception or is abstinent.

Exclusion criteria

  • Has HIV-2 infection.
  • Has hypersensitivity or other contraindication to any of the components of the study drugs as determined by the investigator.
  • Has an active diagnosis of hepatitis due to any cause, including active hepatitis B virus (HBV) infection (defined as hepatitis B surface antigen [HBsAg]-positive or HBV deoxyribonucleic acid [DNA] positive).
  • Has a history of malignancy ≤5 years prior to providing documented informed consent except for adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, or cutaneous Kaposi's sarcoma.
  • Has a history or current evidence of any condition (including active tuberculosis infection), therapy, laboratory abnormality or other circumstance (including drug or alcohol use or dependence) that might, in the opinion of the investigator, confound the results of the study or interfere with the participant's participation for the full duration of the study, such that it is not in the best interest of the participant to participate.
  • Is taking or is anticipated to require systemic immunosuppressive therapy, immune modulators, or any prohibited therapies from 45 days prior to Day 1 through the study treatment period.
  • Is currently taking long-acting cabotegravir-rilpivirine.
  • Is currently participating in or has participated in an interventional clinical study with an investigational compound or device from 45 days prior to Day 1 through the study treatment period.
  • Has a documented or known virologic resistance to DOR/ISL (DOR resistance substitutions in reverse transcriptase: V106A/M, V108I, Y188L, H221Y, P225H, F227C/L, M230I/L, L234I, P236L, or Y318F; ISL resistance substitution in reverse transcriptase: M184V/I).
  • Has exclusionary laboratory values.
  • Is female and expecting to conceive or donate eggs at any time during the study.

Treatment and study plan

DOR/ISL

Drug

100 mg DOR/0.75 mg ISL FDC tablet taken once daily by mouth.

Other names: MK-8591A, Doravirine/islatravir

Primary outcomes

  1. Area Under the Plasma Drug Concentration-time Curve From 0 to 24 Hours Post-dose (AUC0-24) of Islatravir (ISL)

    Time frame: Pre-dose, and 0.5, 1, 2, 4, 8, 12, and 24 hours post-dose on Day 28

    The AUC0-24 of ISL in plasma was determined at steady state.

  2. Maximum Plasma Concentration (Cmax) of ISL

    Time frame: Pre-dose, and 0.5, 1, 2, 4, 8, 12, and 24 hours post-dose on Day 28

    The Cmax of ISL in plasma was determined at steady state.

  3. Time to Reach Maximum Plasma Concentration (Tmax) of ISL

    Time frame: Pre-dose, and 0.5, 1, 2, 4, 8, 12, and 24 hours post-dose on Day 28

    The Tmax of ISL in plasma was determined at steady state.

  4. Apparent Plasma Terminal Half-life (t½) of ISL

    Time frame: Pre-dose, and 0.5, 1, 2, 4, 8, 12, and 24 hours post-dose on Day 28

    The t½ of ISL in plasma was determined at steady state.

  5. Apparent Total Clearance From Plasma (CL/F) of ISL

    Time frame: Pre-dose, and 0.5, 1, 2, 4, 8, 12, and 24 hours post-dose on Day 28

    The CL/F of ISL from plasma was determined at steady state.

  6. Apparent Volume of Distribution During Terminal Phase (Vz/F) of ISL

    Time frame: Pre-dose, and 0.5, 1, 2, 4, 8, 12, and 24 hours post-dose on Day 28

    The Vz/F of ISL was determined at steady state.

  7. AUC0-last of ISL-triphosphate (ISL-TP) in Peripheral Blood Mononuclear Cells (PBMCs)

    Time frame: Pre-dose, and 4 and 24 hours post-dose on Day 28

    The AUC0-24 of ISL-TP in PBMCs was determined at steady state.

  8. Cmax of ISL-TP in PBMCs

    Time frame: Pre-dose, and 4, and 24 hours post-dose on Day 28

    The Cmax of ISL-TP in PBMCs was determined at steady state.

  9. C24 of ISL-TP in PBMCs

    Time frame: 24 hours post-dose on Day 28

    The C24 of ISL-TP in PBMCs was determined at steady state.

  10. Number of Participants Experiencing ≥1 Adverse Event (AE)

    Time frame: Up to 24 weeks

    An AE is any untoward medical occurrence in a clinical study participant, temporally associated with the use of study intervention, whether or not considered related to the study intervention.

  11. Number of Participants Discontinuing From Study Treatment Due to an AE

    Time frame: Up to 24 weeks

    An AE is any untoward medical occurrence in a clinical study participant, temporally associated with the use of study intervention, whether or not considered related to the study intervention.

Secondary outcomes

  1. Percentage of Virologically Suppressed (VS) Participants With HIV-1 Ribonucleic Acid (RNA) ≥50 Copies/mL

    Time frame: Week 24

    The percentage of VS participants with HIV-1 RNA ≥50 copies/mL was determined at the central laboratory with an Abbott Real Time Polymerase Chain Reaction (PCR) assay with a lower limit of detection (LLOD) of 40 copies/mL.

  2. Percentage of VS Participants With HIV-1 RNA <50 Copies/mL

    Time frame: Week 24

    The percentage of VS participants with HIV-1 RNA <50 copies/mL will be determined at the central laboratory with an Abbott Real Time PCR assay with a LLOD of 40 copies/mL.

  3. Percentage of Treatment Naive (TN) Participants With HIV-1 RNA <50 Copies/mL

    Time frame: Week 24

    The percentage of TN participants with HIV-1 RNA <50 copies/mL will be determined at the central laboratory with an Abbott Real Time PCR assay with a LLOD of 40 copies/mL.

  4. Change From Baseline in Cluster of Differentiation 4+ (CD4+) T-cells in VS Participants

    Time frame: Baseline (Day 1) and Week 24

    CD4+ T-cell counts were measured by a central laboratory. Negative and positive results represent a decrease and increase, respectively, from baseline CD4+ T-cell counts.

  5. Change From Baseline in CD4+ T-cells in TN Participants

    Time frame: Baseline (Day 1) and Week 24

    CD4+ T-cell counts were measured by a central laboratory. Negative and positive results represent a decrease and increase, respectively, from baseline CD4+ T-cell counts.

  6. Incidence of Viral Drug Resistance to DOR

    Time frame: Up to 24 weeks

    The number of participants with viral drug resistance to DOR was determined.

  7. Incidence of Viral Drug Resistance to ISL

    Time frame: Up to 24 weeks

    The number of participants with viral drug resistance to ISL was determined.

  8. Palatability of DOR/ISL Tablet

    Time frame: Baseline (Day 1), Week 4, and Week 24

    The palatability of the DOR/ISL tablet (whole or split) was assessed with a modified 5-point facial hedonic scale. Responses ranged from 1 ("very bad") to 5 ("very good"). Data show the number of VS and TN participants responding at each score at the designated time points.

  9. Acceptability of DOR/ISL Tablet

    Time frame: Baseline (Day 1), Week 4, and Week 24

    The acceptability of the DOR/ISL tablet (whole or split) was assessed. Acceptability was assessed by monitoring for refusing the tablet, throwing up or spitting out the tablet, and gagging on the tablet. Data show the number of VS and TN participants responding at each score at the designated time points.

Sponsors and collaborators

Lead sponsor

Merck Sharp & Dohme LLC

Industry

Registry information

Official study title

A Phase 2 Clinical Study to Evaluate the Pharmacokinetics, Safety, and Efficacy of Doravirine/Islatravir in Pediatric Participants With HIV-1 Infection Who Are Virologically Suppressed or Treatment-Naïve, Are Less Than 18 Years of Age, and Weigh Greater Than or Equal to 35 kg

Important dates

Study start
2020
Primary completion
2021
Study completion
2023
First posted
Mar 4, 2020
Registry last updated
Jan 31, 2024

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

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This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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