Phase I/II, Multi-Center, Open-Label Pharmacokinetic, Safety, Tolerability and Antiviral Activity of Dolutegravir, a Novel Integrase Inhibitor, in Combination Regimens in HIV-1 Infected Infants, Children and Adolescents
试验速览
- 阶段
- 1 期
- 状态
- 已完成
- 入组人数
- 181
- 试验地点
- 33
- 主要终点
- Percentage of Participants With Grade 3 or Higher Adverse Events (AEs)
研究概览
简要总结
Dolutegravir (DTG) is an HIV drug in the integrase inhibitor drug class. This study evaluated the pharmacokinetics (PK), safety, tolerability of and immune response to DTG when used concurrently with optimized background therapy (OBT) in HIV-1 infected infants, children, and adolescents.
详细描述
DTG is an HIV medicine in the integrase inhibitor drug class. The purpose of this study was to evaluate the pharmacokinetics, safety, tolerability, and antiviral activity of DTG when used concurrently with OBT in HIV-1 infected infants, children, and adolescents.
Participants in this study were evaluated for PK, safety and tolerability through 48 weeks, followed by additional long-term study follow-up that lasted for approximately 144 weeks (3 years), for a total of 192 weeks on study. This study had two stages. Stage I provided pharmacokinetics, short-term tolerability and safety data on DTG on a limited number of participants to permit dose selection for further study in Stage II. Once a Stage I dose was accepted, enrollment to Stage II began to complete enrollment to the cohort. Stage II provided longer-term safety and antiviral activity data among a larger number of participants.
Infants, children and adolescents with HIV-1, aged ≥ 4 weeks to < 18 years enrolled in the age and formulation cohorts specified below:
- Cohort I: Adolescents ≥ 12 to <18 years of age (film-coated tablets)
- Cohort IIA: Children ≥ 6 to <12 years of age (film-coated tablets)
- Cohort IIB: Children ≥ 6 to <12 years of age (granules for suspension)
- Cohort III: Children ≥ 2 to < 6 years of age (granules for suspension)
- Cohort IV: Children ≥ 6 months to < 2 years of age (granules for suspension)
- Cohort III-DT: Children ≥ 2 to < 6 years of age (dispersible tablets)
- Cohort IV-DT: Children ≥ 6 months to < 2 years of age (dispersible tablets)
- Cohort V-DT: Infants ≥ 4 weeks to < 6 months (dispersible tablets)
Cohorts were opened sequentially according by age group (starting with the older age group), DTG formulation, and study stage, i.e. Initial study enrollment was for Cohort I and progressed to Cohort IIA once Cohort I Stage I met the PK and safety criteria, followed by opening of Cohort IIB. Each cohort enrolled in two sequential stages: Stage I and II (the only exception is Cohort IIB, which only enrolled through Stage I). Sequential enrollment for Cohort III and IV proceeded in the same manner. Cohort V never enrolled because of the recommended changes in dosing and inclusion of enrollment weight band in the criteria for dose finding.
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 4 Weeks 至 17 Years（Child）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Confirmed HIV-1 infection, defined as positive results from two samples collected at different time points (see protocol for more information)
- •Participant belonged to one of the ARV exposure groups below:
- •ARV-treatment experienced (not including receipt of ARVs as prophylaxis or for prevention of perinatal transmission)
- •Previously took ARVs for treatment, but not taking ARVs at study screening.
- •Had been off treatment for greater than or equal to 4 weeks prior to screening, OR
- •At screening, taking ARVs for treatment but failing.
- •Was on an unchanged, failing therapeutic regimen within the 4 to 12 weeks prior to screening (less than or equal to 1 log drop in HIV-1 RNA within the 4 to 12 weeks prior to screening). OR
- •For participants less than 2 years of age, initiated ARVs for treatment less than 4 weeks prior to screening.
- •ARV treatment naive (no exposure to ARVs for treatment; could have received ARVs for prophylaxis or prevention of perinatal transmission)
- •If an infant had received nevirapine (NVP) as prophylaxis to prevent perinatal transmission, he or she did not receive NVP for at least 14 days prior to enrollment into Stage I or II.
- •HIV-1 RNA viral load greater than 1,000 copies/mL of plasma at screening.
- •Demonstrated ability or willingness to swallow assigned study medications.
- •Parent or legal guardian were able and willing to provide signed informed consent.
- •Female participants of reproductive potential, defined as having reached menarche, and who were engaging in sexual activity that could lead to pregnancy, agreed to use two contraceptive methods while on study and for two weeks after stopping study drug.
- •Males engaging in sexual activity that could lead to HIV-1 transmission agreed to use a condom.
- •Agreed to stay on optimized background therapy (OBT) while on study:
- •Participants who at screening were greater than or equal to 2 years of age and ARV-treatment experienced, had at screening at least one fully active drug for the OBT.
- •Participants who were greater than or equal to 2 years of age and ARV-treatment naïve, had genotype testing at screening/entry even with results pending.
- •Participants less than 2 years of age (either ARV-treatment experienced or ARV treatment naïve), had genotype testing at screening/entry even with results pending.
排除标准
- •Presence of any active AIDS-defining opportunistic infection
- •At enrollment, participant less than 3.0 kg
- •Known Grade 3 or greater of any of the following laboratory toxicities within 30 days prior to study entry: neutrophil count, hemoglobin, platelets, aspartate aminotransferase (AST), alanine transaminase (ALT), lipase, serum creatinine and total bilirubin. A single repeat within the 30 days is allowed for eligibility determination. NOTE: Grade 3 total bilirubin was allowable, if the participant was on atazanavir (ATV).
- •ANY known Grade 4 laboratory toxicities within 30 days prior to study entry. NOTE: Grade 4 total bilirubin was allowable, if the participant was on ATV.
- •The following liver toxicities within 30 days prior to study entry: ALT greater than 3x the upper limit of normal (ULN) AND direct bilirubin was greater than 2x ULN
- •Any prior history of malignancy, with the exception of localized malignancies such as squamous cell or basal cell carcinoma of the skin
- •Clinical or symptomatic evidence of pancreatitis, as determined by the clinician
- •Use of any disallowed medications at time of screening (see the protocol for a complete list of disallowed medications)
- •Known history of exposure to integrase inhibitor treatment by the participant or participant's mother prior to delivery/cessation of breastfeeding
- •Known resistance to an integrase inhibitor
- •Women who were pregnant or breastfeeding
- •At screening/entry, participating in or had participated in a study with a compound or device that was not commercially available within 30 days of signing informed consent, unless permission from both Protocol Teams was granted
- •Participant was unlikely to adhere to the study procedures, keep appointments, or was planning to relocate during the study to a non-IMPAACT study site
- •Any clinically significant diseases (other than HIV infection) or clinically significant findings during the screening medical history or physical examination that, in the investigator's opinion, would compromise the outcome of this study
- •At screening/entry had used, or anticipated using, chronic systemic immunosuppressive agents or systemic interferon (e.g., for treatment of hepatitis C virus [HCV] infection) within 30 days prior to beginning DTG study treatment. Systemic corticosteroids (e.g., prednisone or equivalent up to 2 mg/kg/day) for replacement therapy or short courses (less than or equal to 30 days) were permitted. (See protocol for more information on disallowed medications.)
- •Any condition that in the opinion of the site investigator, placed the participant at an unacceptable risk of injury or render the participant unable to meet the requirements of the protocol.
- •Active tuberculosis (TB) disease and/or requirement for treatment that included rifampin at the time of the screening visit. However, participants who needed rifampin treatment while on DTG were allowed to continue in P1093 provided the DTG dose was adjusted according to the protocol.
研究组 & 干预措施
Cohort I
Adolescents 12 to younger than 18 years of age who received DTG film-coated tablets
干预措施: DTG film-coated tablets (Drug)
Cohort IIA
Children 6 to younger than 12 years of age who received DTG film-coated tablets
干预措施: DTG film-coated tablets (Drug)
Cohort IIB
Children 6 to younger than 12 years of age who received DTG granules for suspension
干预措施: DTG granules for suspension (Drug)
Cohort III
Children 2 to younger than 6 years of age who received DTG granules for suspension
干预措施: DTG granules for suspension (Drug)
Cohort IV
Children 6 months to younger than 2 years of age who received DTG granules for suspension
干预措施: DTG granules for suspension (Drug)
Cohort III-DT
Children 2 to younger than 6 years of age who received DTG dispersible tablets
干预措施: DTG dispersible tablets (Drug)
Cohort IV-DT
Children 6 months to younger than 2 years of age who received DTG dispersible tablets
干预措施: DTG dispersible tablets (Drug)
Cohort V-DT
Infants 4 weeks to younger than 6 months of age who received DTG dispersible tablets
干预措施: DTG dispersible tablets (Drug)
结局指标
主要结局
Percentage of Participants With Grade 3 or Higher Adverse Events (AEs)
时间窗: From treatment initiation through Weeks 24 and 48
All grade 3 or higher signs/symptoms, diagnoses, and laboratory AEs were included. AE grading was based on DAIDS AE Grading Table, Version 1.0, December 2004 (Clarification, August 2009). A 2-sided 95% Confidence Interval (CI) was calculated for the percentage using the binominal exact method.
Percentage of Participants With Grade 3 or Higher Adverse Events (AEs) Assessed as Related to Study Drug
时间窗: From treatment initiation through Weeks 24 and 48
All grade 3 or higher signs/symptoms, diagnoses, and laboratory AEs were included. AE grading was based on DAIDS AE Grading Table, Version 1.0, December 2004 (Clarification, August 2009). A 2-sided 95% Confidence Interval (CI) was calculated for the percentage using the binominal exact method.
Number of Participants With Permanent Discontinuation of Study Drug Due to Adverse Events (AEs) Assessed as Related to Study Drug
时间窗: From treatment initiation through Weeks 24 and 48
Number of participants with permanent discontinuation of study drug due to AEs assessed by the site investigator as related to the study drug.
Number of Participants Who Died
时间窗: From treatment initiation through Weeks 24 and 48
Number of participants who died were summarized
PK Parameter: Area-under-the-curve From 0 to 24 Hours (AUC0-24)
时间窗: One intensive PK visit between 5 and 10 days of DTG initiation. At intensive PK visit, blood samples were drawn pre-dose and at 1, 2, 3, 4, 6, 8 and 24 hours post dosing
Pharmacokinetic parameters were determined from plasma concentration-time profiles using non-compartmental methods (Phoenix WinNonlin 8.0 or current, Certara, Princeton, NJ). AUC0-24 was determined using linear up-log down estimation in WinNonlin.
次要结局
- Percentage of Participants With Grade 3 or Higher Adverse Events (AEs)(From treatment initiation through Week 192. AEs after that time were censored.)
- Percentage of Participants With Grade 3 or Higher Adverse Events (AEs) Assessed as Related to Study Drug(From treatment initiation through Week 192. AEs after that time were censored.)
- Number of Participants With Permanent Discontinuation of Study Drug Due to Adverse Events (AEs) Assessed as Related to Study Drug(From treatment initiation through Week 192. AEs after that time were censored.)
- Number of Participants Who Died(From treatment initiation through Week 192. AEs after that time were censored.)
- Percentage of Participants With Plasma HIV-1 RNA Less Than 400 Copies/ml(Week 24 and Week 48)
- Percentage of Participants With Plasma HIV-1 RNA Less Than 50 Copies/ml(Week 24 and Week 48)
- PK Parameter: Plasma Concentration Observed at End of 24 Hour Dosing Interval (C24h)(One intensive PK visit between 5 and 10 days of DTG initiation. At intensive PK visit, blood samples were drawn pre-dose and at 1, 2, 3, 4, 6, 8 and 24 hours post dosing)
- PK Parameter: Plasma Concentration Observed Immediately to Dosing of 24 Hour Dosing Interval (C0h)(One intensive PK visit between 5 and 10 days of DTG initiation. At intensive PK visit, blood samples were drawn pre-dose and at 1, 2, 3, 4, 6, 8 and 24 hours post dosing)
- PK Parameter: Minimum Plasma Concentration (Cmin)(One intensive PK visit between 5 and 10 days of DTG initiation. At intensive PK visit, blood samples were drawn pre-dose and at 1, 2, 3, 4, 6, 8 and 24 hours post dosing)
- PK Parameter: Maximum Plasma Concentration (Cmax)(One intensive PK visit between 5 and 10 days of DTG initiation. At intensive PK visit, blood samples were drawn pre-dose and at 1, 2, 3, 4, 6, 8 and 24 hours post dosing)
- PK Parameter: Apparent Clearance (CL/F)(One intensive PK visit between 5 and 10 days of DTG initiation. At intensive PK visit, blood samples were drawn pre-dose and at 1, 2, 3, 4, 6, 8 and 24 hours post dosing)
- PK Parameter: Apparent Volume of Distribution (Vz/F)(One intensive PK visit between 5 and 10 days of DTG initiation. At intensive PK visit, blood samples were drawn pre-dose and at 1, 2, 3, 4, 6, 8 and 24 hours post dosing)
- Genotypic Measures of Resistance to Reverse Transcriptase(at virologic failure at or prior to Week 192)
- PK Parameter: Terminal Half-life (t1/2)(One intensive PK visit between 5 and 10 days of DTG initiation. At intensive PK visit, blood samples were drawn pre-dose and at 1, 2, 3, 4, 6, 8 and 24 hours post dosing)
- Summary of Changes in CD4 Count From Baseline(Measured at Day 0, Week 24, and Week 48)
- Summary of Changes in CD4 Percent From Baseline(Measured at Day 0, Week 24, and Week 48)
- Summary of Changes in CD8 Count From Baseline(Measured at Day 0, Week 24, and Week 48)
- Summary of Changes in CD8 Percent From Baseline(Measured at Day 0, Week 24, and Week 48)
- Genotypic Measures of Resistance to Integrase(at virological failure visit at or prior to Week 192)
- Genotypic Measures of Resistance to Protease(at virological failures at or prior to Week 192)
- Phenotypic Measures of Resistance(Whenever virological failures took place from baseline to week 192)
- Worst Case CDC HIV Classification Status(From baseline through Week 192)