A Prospective and Retrospective Observational Study of Multidrug-Resistant Patient Outcomes With and Without Ibalizumab
- Conditions
- HIV InfectionsMulti-Antiviral Resistance
- Interventions
- Other: No ibalizumab or Pre-ibalizumab treatment
- Registration Number
- NCT05388474
- Lead Sponsor
- Theratechnologies
- Brief Summary
The virological efficacy of ibalizumab has been clearly demonstrated in multiple clinical trials. This study will expand ibalizumab's clinical data set and allow a better understanding of the virologic response durability on ARV regimens with or without ibalizumab in a heterogeneous real-world patient population. Additional data on the efficacy and safety of ibalizumab and its impact on patient reported outcomes will be captured until study end.
Primary Objective:
To evaluate the long-term efficacy, safety, and durability of ibalizumab in combination with other ARVs by comparing the virologic, immunologic and clinical outcomes of patients receiving ibalizumab treatment versus patients not receiving ibalizumab.
Secondary Objective:
To assess the efficacy of ibalizumab in combination with other antiretrovirals by comparing the virologic, immunologic, clinical and patient reported outcomes of patients before and after they receive ibalizumab treatment.
To assess the long-term safety and tolerability of ibalizumab.
Other Objectives:
To assess risk factors/predictors of virologic and immunologic response. To assess efficacy and safety in special populations that enroll.
- Detailed Description
Antiretroviral therapy (ART) for treatment of human immunodeficiency virus (HIV) has evolved tremendously over recent years. Newer medications have superior efficacy and tolerability, affording more convenient treatment regimens. The proportion of patients receiving antiretroviral (ARV) treatment that maintain viral suppression is approximately 85% in the United States. However, some patients may not be able to adhere to the prescribed ARV regimen or harbour strains of HIV that are resistant to most currently available therapies. Multi-drug resistant (MDR) HIV may be transmitted or result from incomplete viral suppression, which leads to accumulation of mutations in the viral genome over time. Patients with MDR HIV infection have significantly fewer available treatment options to construct a fully suppressive regimen. This ultimately results in shorter life expectancy, greater potential for transmission of MDR virus, increased morbidity and greater use of health resources. These comparisons are valid for the general population as well as people infected with non-MDR virus.
Ibalizumab, a humanized IgG4 monoclonal antibody that binds to a conformational epitope on domain 2 of the extracellular portion of the CD4 receptor, belongs to a new class of ARVs, CD4-directed post-attachment HIV-1 inhibitors, Ibalizumab exhibits no known cross-resistance with other ARV medications. Ibalizumab was approved by the FDA on March 6, 2018 and is indicated in combination with other ARVs for the treatment of HIV-1 infection in heavily treatment-experienced adults with MDR HIV-1 infection failing their current ARV regimen. It has been available commercially from April 2018.
The safety, efficacy and durability of response to ibalizumab treatment in combination with other ARVs have been demonstrated in clinical trials. This registry is designed to better understand the long-term efficacy and safety outcomes of MDR patients with and without ibalizumab in a real-world scenario.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 200
- The patient is Heavily treatment-experienced (HTE), with limited treatment options and a history of treatment failure;
- Based on recent or historical resistance assays and ARV history, patients must have documented Multi Drug Resistant (MDR) HIV-1 (e.g., laboratory report and documented past ARV treatment);
- Received an appropriate HIV-1 resistance assay (genotypic or phenotypic testing) to devise an OBR (which may include an investigational ARV treatment) or will receive an appropriate resistance assay prior to initiating ibalizumab treatment;
- Provide signed and dated informed consent to the Investigator, indicating that the patient (or, legally acceptable representative) has been informed of all pertinent aspects of the study, and is capable of understanding and willing to comply with the registry requirements. The consent will request to access the patient's medical, hospital, pharmacy, and vital statistics records as appropriate, as well as historical medical data for the full retrospective time period (01 May 2018 to enrollment). Further, consent will be provided for access to all available historical resistance and ARV treatment data;
- ≥18 years of age or older at the time of screening;
- Provide information on at least one alternate contact person of their choice (primary care physician, close relative or emergency contact) who can be contacted, should the patient be lost to follow-up over the course of the study;
- Acknowledgement that in the event of their death, additional information can be obtained by contacting their primary care physician, a close relative, emergency contact or by consulting public or external databases (death registries, obituary listings) when available and verifiable. This is to be done in accordance with local regulatory requirements and laws;
- Exceptionally, patients who may have started ibalizumab outside of the approved indication can also be included in Cohort 2 of the registry at the discretion of the investigator, provided they determine clinical utility.
- Pregnant or breastfeeding;
- Unable to provide informed consent;
- Hypersensitivity to ibalizumab or any of the excipients in ibalizumab;
- Previous ibalizumab experience (Cohort 1 only)
- Previously enrolled in Cohort 2 of this registry.
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description Cohort 2 (On ibalizumab treatment): On ibalizumab treatment This cohort will be comprised of Heavily Treatment-Experienced patients (HTE) with Multi Drug Resistant (MDR) HIV who are starting treatment with an ARV regimen that includes ibalizumab. Patients already receiving ibalizumab prior to study entry may also be included in Cohort 2 if baseline viral load (VL) and cluster of differentiation 4 (CD4) count data are available prior to ibalizumab treatment. Recruited patients will be required to consent to provide their full retrospective ARV treatment and drug resistance history, as well as retrospective historical data from their medical records from 01 May 2018 to enrollment. Cohort 1 (No ibalizumab or Pre-ibalizumab treatment): No ibalizumab or Pre-ibalizumab treatment This cohort will be comprised of Heavily treatment-experienced (HTE) patients with Multi Drug Resistant (MDR) HIV who are not receiving ibalizumab. These patients will roll-over into cohort 2 if a change to their ARV regimen is made to include ibalizumab.
- Primary Outcome Measures
Name Time Method Primary Outcome measures Maximum 36 months ON-TREATMENT INFORMATION:
* CD4 count (cells/mm3)
* Viral Load (copies/ml)
* Weight (kilograms)
* HIV subtype when available for patient
* Concomitant medication review
* Resistance testing review
* Optimized Background Regimen review
* New AIDS-Defining Events (CDC classification)
* Adverse Reactions/Serious Adverse reactions review
* Hospitalizations review
* Ibalizumab discontinuation date and reason (e.g., lost to follow-up, death).
- Secondary Outcome Measures
Name Time Method
Related Research Topics
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Trial Locations
- Locations (36)
Indiana University Health Inc.
🇺🇸Bloomington, Indiana, United States
Ruane Clinical Research
🇺🇸Los Angeles, California, United States
Mills Clinical Research
🇺🇸Los Angeles, California, United States
BIOS Clinical Research
🇺🇸Palm Springs, California, United States
UC San Diego Owen Clinic
🇺🇸San Diego, California, United States
Yale University
🇺🇸New Haven, Connecticut, United States
Circle Care Center
🇺🇸Stamford, Connecticut, United States
Waterbury Hospital
🇺🇸Waterbury, Connecticut, United States
Whitman Walker Health
🇺🇸Washington, District of Columbia, United States
Georgetown University Medical Center
🇺🇸Washington, District of Columbia, United States
Aids Healthcare Foundation
🇺🇸Fort Lauderdale, Florida, United States
Gary J. Richmond, M.D., PA
🇺🇸Fort Lauderdale, Florida, United States
Bliss Health
🇺🇸Orlando, Florida, United States
CAN Community Health
🇺🇸Tampa, Florida, United States
Triple O Research Institute PA
🇺🇸West Palm Beach, Florida, United States
Amity Medical Group
🇺🇸Charlotte, North Carolina, United States
The Roper St. Francis Ryan White Wellness Center
🇺🇸Charleston, South Carolina, United States
Medical University of South Carolina
🇺🇸Charleston, South Carolina, United States
Prism Health North Texas
🇺🇸Dallas, Texas, United States
North Texas Infectious Diseases Consultants, P.A
🇺🇸Dallas, Texas, United States
Midway Specialty Care Center Miami Beach
🇺🇸Miami Beach, Florida, United States
Orlando Immunology Center (OIC)
🇺🇸Orlando, Florida, United States
Can Community Health
🇺🇸Tampa, Florida, United States
St-Joseph's Comprehensive Research
🇺🇸Tampa, Florida, United States
University of Maryland School of Medicine
🇺🇸Baltimore, Maryland, United States
Boston Medical Center
🇺🇸Boston, Massachusetts, United States
The Research Institute
🇺🇸Springfield, Massachusetts, United States
Henry Ford Hospital
🇺🇸Detroit, Michigan, United States
Las Vegas Research Center
🇺🇸Las Vegas, Nevada, United States
I.D. Care Associates, PA
🇺🇸Hillsborough, New Jersey, United States
Prime Healthcare Services - St Michael's Medical Center
🇺🇸Newark, New Jersey, United States
SUNY Upstate Medical Center
🇺🇸Syracuse, New York, United States
Therapeutic Concepts, PA
🇺🇸Houston, Texas, United States
UT Health Houston
🇺🇸Houston, Texas, United States
St. Hope Foundation
🇺🇸Houston, Texas, United States
Legacy Community Pharmacy Services
🇺🇸Houston, Texas, United States