WRHI 060 (ADVANCE): A Randomised, Phase 3 Non-inferiority Study of DTG + TAF + FTC Compared With DTG + TDF + FTC and EFV + TDF + FTC in Patients Infected With HIV-1 Starting First-line Antiretroviral Therapy - Extension to 192 Weeks
试验速览
- 阶段
- 3 期
- 状态
- 已完成
- 发起方
- 入组人数
- 1,110
- 试验地点
- 4
- 主要终点
- Proportion of patients with undetectable plasma HIV-1 RNA levels (< 50 copies/mL) at Week 48
研究概览
简要总结
This is a non-inferiority (10% non-inferiority margin), study to assess the efficacy and safety of dolutegravir, DTG (50 mg once daily [QD]) administered in combination with tenofovir alafenamide fumarate, TAF (25 mg QD) and emtricitabine, FTC (200 mg QD) compared to DTG (50 mg QD) administered in combination with tenofovir disoproxil fumarate, TDF (300 mg QD) and FTC (200 mg QD) and compared to efavirenz, EFV (600 mg QD) administered in combination with TDF (300 mg QD) and FTC (200 mg QD) through 96 weeks in patients with HIV-1 starting first-line ART.
详细描述
This is an open label randomised, non-inferiority (10% non-inferiority margin), phase 3 study to assess the efficacy and safety of DTG (50 mg once daily [QD]) administered in combination with TAF (25 mg QD) and FTC (200 mg QD) compared to DTG (50 mg QD) administered in combination with TDF (300 mg QD) and FTC (200 mg QD) and compared to EFV (600 mg QD) administered in combination with TDF (300 mg QD) and FTC (200 mg QD) through 96 weeks in patients with HIV-1 starting first-line ART.
Approximately 1110 male and female patients infected with HIV-1 who are eligible for first-line ART will be randomly assigned in a 1:1:1 ratio (approximately 370 patients per treatment group) to Treatment Group 1 (DTG + TAF + FTC) or Treatment Group 2 (DTG + TDF + FTC) or Treatment Group 3 (EFV + TDF + FTC). To ensure adequate representation of adolescents (12 - 18 years) in any treatment group, randomisation will be stratified according to age greater or less than 18 years. The study includes screening and baseline visits, 8 study visits from Week 4 to Week 84, and a preliminary end of study visit at Week 96.
The study will then take patients on Treatment Group 1 (DTG + TAF + FTC) or Treatment Group 2 (DTG + TDF + FTC) or Treatment Group 3 (EFV + TDF + FTC), who have completed 96 weeks successfully, and follow them to 192 weeks, with visits every 24 weeks after enrolment to 192 weeks. Study medication pill counts will be performed at each follow-up visit.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 12 Years 至 —（Child, Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Age ≥ 12 years and ≥ 40 kg
- •Documented laboratory diagnosis of infection with HIV-1 (positive enzyme-linked immunosorbent assay HIV-1 antibody test) at screening
- •Plasma HIV-1 RNA (VL) ≥ 500 copies/mL
- •All pre-existing medical or laboratory abnormalities must be deemed to be stable by the investigator prior to study enrolment
- •Calculated creatinine clearance (CrCl) > 60 mL/min (Cockcroft-Gault formula) in > 18 years old OR > 80 mL/min (modified Cockcroft-Gault) in ≤ 18 years old
- •Ability to comprehend the full nature and purpose of the study, in the opinion of the investigator, and to comply with the requirements of the entire study.
- •To enrol in extension post-96 weeks:
- •Each patient must meet all of the following criteria to be enrolled in this study:
- •Previously enrolled on the ADVANCE study, and followed to week 96 (including those on post-trial access)
- •Ability to comprehend the full nature and purpose of the study, including the extended timeline, in the opinion of the investigator, and to comply with the requirements of the entire study.
排除标准
- •Previously received more than 30 days of treatment with any form of antiretroviral therapy (ART) or
- •Received any antiretrovirals within the last 6 months
- •Women who are pregnant at the time of the screening or baseline visit
- •Active tuberculosis and/or are on antituberculous therapy at the time of the baseline visit
- •Taking and cannot discontinue prohibited concomitant medications listed in 7.3 at least 2 weeks prior to the baseline visit and for the duration of the study period
- •Clinically unstable, in the investigator's opinion
- •Current history of drug or alcohol abuse that, in the opinion of the investigator, may be an impediment to patient adherence to the protocol
- •Patients who participated in a study with an investigational drug within 60 days of screening or who are currently receiving treatment with any other investigational drug or device may be ineligible to participate. This is an investigator decision
- •Have a strong likelihood of relocating far enough to make access to the study site difficult
- •History or presence of allergy to the study drugs or their components
- •Unstable liver disease (as defined by the presence of ascites, encephalopathy, coagulopathy, hypoalbuminaemia, oesophageal or gastric varices, or persistent jaundice), cirrhosis, known biliary abnormalities (with the exception of Gilbert's syndrome or asymptomatic gallstones); Child-Pugh C.
- •To enrol in extension post-96 weeks:
- •Patients meeting the following criteria will be excluded from the study:
- •HbA1c, lipids and blood pressures that are not responding to treatment, in the opinion of the investigator and in consultation with the principal investigator, justifying substitution of DTG or TAF
- •Clinically unstable, in the opinion of the investigator
- •Have a strong likelihood of relocating far enough to make access to the study site difficult.
研究组 & 干预措施
Tenofovir Alafenamide
Descovy: Tenofivir alafenamide tablets 25mg daily, Emtricitabine 200mg daily
干预措施: Dolutegravir (Drug)
Tenofovir Alafenamide
Descovy: Tenofivir alafenamide tablets 25mg daily, Emtricitabine 200mg daily
干预措施: Tenofovir Alafenamide (Drug)
Dolutegravir
Dolutegravir 50mg daily, Truvada 500mg daily
干预措施: Dolutegravir (Drug)
Dolutegravir
Dolutegravir 50mg daily, Truvada 500mg daily
干预措施: Truvada (Drug)
Atripla
Atripla: Efavirenz 600mg daily, Tenofovir Disoproxil Fumarate 300mg daily, Emtricitabine 200mg daily
干预措施: Atripla (Drug)
结局指标
主要结局
Proportion of patients with undetectable plasma HIV-1 RNA levels (< 50 copies/mL) at Week 48
时间窗: 48 weeks
The proportion of participants with undetectable plasma HIV-1 RNA levels at Week 48, will be calculated for each treatment group and summarised.
次要结局
- Proportion of patients with undetectable plasma HIV-1 RNA levels (< 50 copies/mL) at Week 48, 96, 144 and 192(192 weeks)
- Proportion of patients with plasma HIV-1 RNA levels < 200 copies/mL at Week 192(192 weeks)
- Time to virologic failure (defined as confirmed HIV-1 RNA levels ≥ 1000 copies/mL at week 12 - 24 or ≥ 200 copies/mL at or after week 24)(24 weeks)
- Change from baseline in plasma HIV-1 RNA levels at each visit(At week 12, 24, 36, 60, 72, 84, 96, 120, 144, 168, 192)
- Change from baseline in plasma CD4 levels at each visit(At week 12, 24, 36, 60, 72, 84, 96, 120, 144, 168, 192)
研究者
Professor Francois Venter
Professor
University of Witwatersrand, South Africa