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Completed

NCT Number: NCT02067767

Multicentric Open-label Study of Switch From Abacavir/Lamivudine Fixed Dose Combination Plus Nevirapine to Abacavir/Lamivudine/Dolutegravir in Virologically Suppressed HIV-1 Infected Adults (SWAD)

Abacavir/Lamivudine + Nevirapine (ABC/3TC + NVP) is a very effective and well tolerable regimen on the long-term. However this regimen comprises 2 pills per day. Abacavir/Lamivudine/Dolutegravir (ABC/3TC/DTG) offers simplification with a single pill per day with no food constraints, Dolutegravir (DTG) having the advantage over Nevirapine (NVP) of high potency, higher genetic barrier to resistance, with a very good safety profile. The objective of this study is to evaluate the virologic safety (maintenance of virologic suppression) after switching from ABC/3TC + NVP to ABC/3TC/DTG in 50 HIV-1 infected adults with prolonged HIV RNA suppression on ABC/3TC + NVP, as well as clinical and laboratory safety. Because nevirapine is a strong inducer of hepatic enzymes, pharmacocinetic (PK) assessment will be performed in all patients in the first weeks after switch and 24-hours PK in a subset of 10 patients after 5 days of DTG addition to current regimen, before switching to ABC/3TC/DTG.

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Key information

Conditions

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Phase 2

Primary location

La Roche-sur-Yon Hospital, La Roche-sur-Yon, France

Loading trial locations.

Who can participate

Healthy volunteers accepted: No

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

Inclusion criteria

  • Patient with confirmed HIV-1 infection (HIV antibody positive confirmation prior to screening)
  • Age ≥ 18 years
  • Written informed consent
  • Male patient or non-pregnant, non-lactating female patient
  • On antiretroviral treatment with nevirapine (400 mg per day) plus abacavir/lamivudine for more than 6 months; Nevirapine 400 mg/day being administered as either 1 x 200 mg IR x 2/day or 2 x 200 mg IR qd or 1 x 400 mg XR qd
  • No history of prior virologic failure on antiretroviral therapy
  • HIV-1 RNA < 50 copies/ml for more than 1 year,
  • No major IAS-USA nucleoside reverse transcriptase inhibitors or integrase inhibitors resistance mutations on genotypic testing on last plasma sample with HIV-1 RNA > 500 c/mL (if available)
  • HLA-B*5701 negative test
  • Subjects covered by Health Insurance

Exclusion criteria

  • Woman of child-bearing potential without effective contraception method. Pregnant or breastfeeding woman.
  • Woman expecting to conceive during the study period
  • HIV-2 co-infection
  • Any prior exposure to integrase inhibitor(s)
  • Plasma HIV-1 RNA > 50 c/mL in the past year
  • Creatinine clearance < 60 ml/mn (estimated glomerular filtration rate according to the MDRD equation),
  • Alkaline phosphatase, ASAT or ALAT ≥ 5 times the upper limit of the norm (ULN)
  • Patient with history of decompensated liver disease
  • Any major IAS-USA mutation conferring resistance to one or more of reverse transcriptase or integrase inhibitors on any historical plasma genotype if available. Any previous genotype result is valid, with no time limit, as long as the original test result is documented.
  • Mycobacteriosis under treatment
  • Malignancy requiring chemotherapy or radiotherapy
  • Positive HBs Ag
  • HCV infection for which specific treatment is ongoing or planned during the study
  • Known hypersensitivity to one of the trial drugs, the metabolites or formulation excipients
  • Concomitant therapy with antacids or H2 antagonists
  • Contraindicated concomitant treatment
  • Anticipated non-compliance with the protocol
  • Participation in another clinical trial with an on-going exclusion period at screening
  • Subject under legal guardianship or incapacitation
  • Subject, who in the opinion of the investigator, is unable to complete the study period

Treatment and study plan

Abacavir/Lamivudine/Dolutegravir

Drug

At Day 1 (D1):

  • group 1 will switch their ongoing treatment of ABC/3TC + NVP to ABC/3TC/DTG ;
  • group 2 will continue NVP and switch ABC/3TC to ABC/3TC/DTG for 6 days (D-5 to D0), then stop NVP from D1.

Primary outcomes

  1. Percentage of patients with plasma HIV-1 RNA < 50 copies/mL at week 12

    Time frame: Week 12

Secondary outcomes

  1. Percentage of patients with Plasma HIV-1 RNA < 50 copies/ml at W24

    Time frame: Week 24

  2. Percentage of patients with Plasma HIV-1 RNA < 50 copies/ml at W48

    Time frame: Week 48

  3. Percentage of patients with undetectable plasma viral load (< 1 copies/ml or signal not detected) at W12

    Time frame: Week 12

  4. Number of patients with undetectable plasma viral load (< 1 copies/ml or signal not detected) at W24

    Time frame: Week 24

  5. Number of patients with undetectable plasma viral load (< 1 copies/ml or signal not detected) at W36

    Time frame: Week 36

  6. Number of patients with undetectable plasma viral load (< 1 copies/ml or signal not detected) at W48

    Time frame: Week 48

  7. Percentage of patients with adverse event of any Grade over 12 weeks

    Time frame: Week 12

  8. Percentage of patients with adverse event of Grade 3 or 4 over 48 weeks

    Time frame: Week 48

  9. CD4 and CD8 measurement

    Time frame: Week 48

    Changes in CD4 and CD8 counts over 48 weeks

  10. Serum creatinine and GFR (MDRD) measurement

    Time frame: Week 48

    Changes in serum creatinine, and GFR (MDRD) from W2 to W48

  11. Urinary albumine:creatinine ratio measurement

    Time frame: Week 48

    Change in urinary albumine:creatinine ratio over 48 weeks

  12. Fasting lipids measurement

    Time frame: Week 48

    Changes in fasting lipids over 48 weeks

  13. Plasma concentration of NVP between Week 0 (W0) and Week 2 (W2)

    Time frame: Week 2

    The mean plasma concentration of nevirapine is measured between W0 and W2 (D0, W1, W2)

  14. Plasma concentration of dolutegravir between W0 and W12

    Time frame: Week 12

    The mean plasma concentration of dolutegravir is measured between W0 and W12 (W1, W2, W4, W12)

  15. CD14 and usCRP measurement over 48 weeks

    Time frame: Week 48

    Changes in sCD14 and usCRP over 48 weeks (stored plasma)

  16. Evaluation of patient's satisfaction with HIVTSQs and HIVTSQc questionnaires

    Time frame: Week 48

    Patient's satisfaction, evaluated with self-administered questionnaires HIVTSQs and HIVTSQc

  17. Plasma concentration of DTG on 24h at D0 and Week 2

    Time frame: Week 2

    24h PK parameters of DTG (D0, after 5 days of combination of ABC/3TC + NVP + DTG) with and without NVP (D14)

Sponsors and collaborators

Lead sponsor

Nantes University Hospital

Other

Registry information

Official study title

Phase 2 Multicentric Open-label Study of Switch From Abacavir/Lamivudine Fixed Dose Combination Plus Nevirapine to Abacavir/Lamivudine/Dolutegravir in Virologically Suppressed HIV-1 Infected Adults

Acronym: SWAD

Important dates

Study start
2014
Primary completion
2015
Study completion
2015
First posted
Feb 20, 2014
Registry last updated
Feb 22, 2016

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

View the official ClinicalTrials.gov record (opens in a new tab)

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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