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    Summary
    EudraCT Number:2013-001969-16
    Sponsor's Protocol Code Number:GS-US-183-0160
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Completed
    Date on which this record was first entered in the EudraCT database:2013-10-01
    Trial results View results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedSpain - AEMPS
    A.2EudraCT number2013-001969-16
    A.3Full title of the trial
    A Phase 2/3 Multicenter, Open-Label, Multicohort, Two-Part Study Evaluating the Pharmacokinetics (PK), Safety, and Antiviral Activity of Elvitegravir (EVG) Administered with a Background Regimen (BR) Containing a Ritonavir-Boosted Protease Inhibitor (PI/r) in HIV-1 Infected, Antiretroviral Treatment-Experienced Pediatric Subjects.
    Estudio de fase 2/3 multicéntrico, abierto, multicohorte, de dos partes para evaluar la farmacocinética (FC), la seguridad y la actividad antiviral de elvitegravir (EVG) administrado con un régimen de base (RB) que contiene un inhibidor de la proteasa reforzado con ritonavir (IP/r) en sujetos pediátricos infectados por el VIH 1 previamente tratados con antirretrovirales
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A study to investigate the dose, safety and effectiveness of an experimental drug called elvitegravir for the treatment of HIV infection in children and adolescent patients. Patients must have previously received treatment for their HIV infection, and elvitegravir will be added to their current treatment which must include a ritonavir-boosted protease inhibitor.
    Estudio para investigar la dosis, seguridad y efectividad de un medicamento experimental llamado elvitegravir para el tratamiento de la infección por VIH en niños y adolescentes. Los pacientes deben haber recibido previamente tratamiento para la infección por VIH y elvitegravir será añadido a su actual tratamiento el cual incluye un inhibidor de la proteasa potenciado por ritonavir.
    A.4.1Sponsor's protocol code numberGS-US-183-0160
    A.7Trial is part of a Paediatric Investigation Plan Yes
    A.8EMA Decision number of Paediatric Investigation PlanP/066/2013
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorGilead Sciences, Inc.
    B.1.3.4CountryUnited States
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportGilead Sciences, Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationGilead Sciences International Ltd.
    B.5.2Functional name of contact pointClinical Trials Information
    B.5.3 Address:
    B.5.3.1Street AddressFlowers Building, Granta Park
    B.5.3.2Town/ cityGreat Abington, Cambridge
    B.5.3.3Post codeCB21 6GT
    B.5.3.4CountryUnited Kingdom
    B.5.4Telephone number+441223897 496
    B.5.5Fax number+441223897 284
    B.5.6E-mailclinicaltrials@gilead.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameElvitegravir
    D.3.2Product code EVG, GS-9137
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNELVITEGRAVIR
    D.3.9.1CAS number 697761-98-1
    D.3.9.2Current sponsor codeGS-9137/EVG
    D.3.9.3Other descriptive nameELVITEGRAVIR
    D.3.9.4EV Substance CodeSUB30999
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number85
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameElvitegravir
    D.3.2Product code EVG, GS-9137
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation Yes
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNELVITEGRAVIR
    D.3.9.1CAS number 697761-98-1
    D.3.9.2Current sponsor codeGS-9137/EVG
    D.3.9.3Other descriptive nameELVITEGRAVIR
    D.3.9.4EV Substance CodeSUB30999
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number50
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 3
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameElvitegravir
    D.3.2Product code EVG, GS-9137
    D.3.4Pharmaceutical form Powder for oral suspension
    D.3.4.1Specific paediatric formulation Yes
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNELVITEGRAVIR
    D.3.9.1CAS number 697761-98-1
    D.3.9.2Current sponsor codeGS-9137/EVG
    D.3.9.3Other descriptive nameELVITEGRAVIR
    D.3.9.4EV Substance CodeSUB30999
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number5
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 4
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameElvitegravir
    D.3.2Product code EVG, GS-9137
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNELVITEGRAVIR
    D.3.9.1CAS number 697761-98-1
    D.3.9.2Current sponsor codeGS-9137/EVG
    D.3.9.3Other descriptive nameELVITEGRAVIR
    D.3.9.4EV Substance CodeSUB30999
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number150
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Human Immunodeficiency Virus (HIV-1) Infections
    Infección por virus de la inmunodeficiencia humana (VIH-1)
    E.1.1.1Medical condition in easily understood language
    Human Immunodeficiency Virus (HIV-1) Infections
    Infección por virus de la inmunodeficiencia humana (VIH-1)
    E.1.1.2Therapeutic area Diseases [C] - Virus Diseases [C02]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 16.0
    E.1.2Level LLT
    E.1.2Classification code 10020192
    E.1.2Term HIV-1
    E.1.2System Organ Class 100000004862
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    The primary objectives of this study are:

    -To evaluate the steady-state PK and confirm the dose of EVG/r in HIV-1 infected, antiretroviral treatment-experienced subjects 4 weeks to less than 18 years of age.

    -To evaluate the safety and tolerability of EVG/r in HIV-1 infected, antiretroviral treatment-experienced subjects 4 weeks to <18 years of age.
    Los objetivos principales de este estudio son:
    -Evaluar la FC en estado de equilibrio y confirmar la dosis de EVG/r en sujetos de entre 4 semanas y menos de 18 años de edad infectados por el VIH 1 previamente tratados con antirretrovirales.
    -Evaluar la seguridad y la tolerabilidad de EVG/r en sujetos de entre 4 semanas y menos de 18 años de edad infectados por el VIH 1 previamente tratados con antirretrovirales.
    E.2.2Secondary objectives of the trial
    The secondary objective of this study is:

    -To evaluate the antiviral activity of EVG/r in HIV-1 infected, antiretroviral
    treatment-experienced subjects 4 weeks to <18 years of age who are failing their current
    HAART regimen
    El objetivo secundario de este estudio es:
    -Evaluar la actividad antiviral de EVG/r en sujetos de entre 4 semanas y menos de 18 años de edad infectados por el VIH 1 previamente tratados con antirretrovirales que no estén respondiendo al régimen presente de TARGA.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    Subjects must meet all of the following inclusion criteria to be eligible for participation in this study.

    4.2.1.HIV-1 infected male and female subjects 4 weeks (gestational age of at least 44 weeks) to < 18 years of age at the Baseline visit (according to Cohort).

    4.2.2.Subjects are able to provide written assent if they have the ability to read and write.

    4.2.3.Parent or legal guardian able to provide written informed consent prior to any screening evaluations and willing to comply with study requirements.

    4.2.4.Body weight at screening as follows:
    -Cohort 2 greater than 15 kg
    -Cohort 3 greater than 10.6 kg
    -Cohort 4 greater than 5 kg

    4.2.5.Adequate renal function: Estimated Glomerular Filtration Rate (eGFR) >o= 90 mL/min/1.73m2 using the Schwartz Formula.

    4.2.6.Adequate hematologic function defined as:
    ?Absolute neutrophil count > 500 cells/mm3 (Note: Subjects with chronic neutropenia, defined as having an ANC of < 500/mm3 documented at least twice within 6 months of screening, and in whom, according to the investigator, there is no evidence of active opportunistic or serious infection can enroll in the study contingent upon approval from the Gilead Medical Monitor.)
    ?Hemoglobin > 8.5 g/dL (9.5 g/dL for infants less than 35 days of age)
    ?Platelets > 50,000/mm3

    4.2.7.Hepatic transaminases (AST and ALT) <o= 5 x upper limit of normal (ULN)

    4.2.8.Total bilirubin <o= 1.5 mg/dL, or normal direct bilirubin

    4.2.10.Negative serum ?-HCG pregnancy test for female subjects (of childbearing potential only, as defined in Section 7.8).

    4.2.11.For subjects with evidence of suppressed viremia (Part A only):
    -Plasma HIV-1 RNA concentration (at least 2 consecutive measurements) at an undetectable level according to the assay being used for at least 3 months prior to screening, and HIV-1 RNA <50 copies/mL (Roche COBAS TaqMan v2.0) at screening.
    -Stable antiretroviral regimen including one of the following PI/r for at least 3 months prior to screening: lopinavir/r (Kaletra), atazanavir/r, darunavir/r, tipranavir/r, or fosamprenavir/r. Subjects undergoing dose modifications to their antiretroviral regimen for growth or switching medication formulations are considered to be on a stable antiretroviral regimen.

    4.2.12.For subjects failing a current antiretroviral regimen at study entry (Parts A and B):
    -HIV-1 RNA >1,000 copies/mL at screening (Roche COBAS TaqMan v2.0).
    -Prior treatment for HIV-1 infection, defined as 6 months of antiretroviral treatment experience (with the exception of Cohort 4 where less than 6 months of treatment experience is acceptable) and at least 1 documented resistance mutation as defined by current IAS-USA Guidelines. These resistance gene mutations must be documented in a historical genotype report(s), or in the genotype report at screening provided by Gilead Sciences.
    -Stable antiretroviral regimen (or no antiretroviral regimen) for at least 30 days prior to screening. Subjects undergoing dose modifications to their antiretroviral regimen for growth or switching medication formulations are considered to be on a stable antiretroviral regimen.
    -Screening genotype must show full sensitivity to EVG.
    -Ability to construct a BR that must contain one of the following fully active PI/r: lopinavir/r (Kaletra), atazanavir/r, darunavir/r, tipranavir/r, or fosamprenavir/r. (Fully active is defined by genotypic analysis.)
    -Genotypic sensitivity score (GSS) of at least 2 (including the fully active PI/r and EVG).
    -No opportunistic infection within 30 days of study entry.

    4.2.13.Male and female subjects of childbearing potential (as defined in Section 7.8) must agree to utilize highly effective contraception methods while on study treatment or agree to abstain from heterosexual intercourse throughout the study period and for 30 days following the last dose of study drug; highly effective methods normally utilize two separate forms of contraception, one of which must be an effective barrier contraceptive method. Pre-pubertal females (Tanner Stages 1 and 2 are not considered to be of childbearing potential, unless onset of menarche has occurred. See Section 7.8 for definition of females of childbearing potential).
    -Female subjects who utilize hormonal contraceptive as one of their birth control methods must have used the same method for at least three months prior to study dosing. It is recommended that an oral contraceptive contain at least 30 ?g of ethinyl estradiol if administered with EVG.

    4.2.14.Must be willing and able to comply with all study requirements.
    4.2.1.Sujetos de ambos sexos infectados por el VIH 1 de entre 4 semanas (edad gestacional de al menos 44 semanas) y menos de 18 años de edad en la visita basal (según la cohorte).
    4.2.2.Los sujetos son capaces de otorgar su asentimiento por escrito en caso de que sepan leer y escribir.
    4.2.3.El progenitor o tutor legal es capaz de otorgar su consentimiento informado por escrito antes de realizar ninguna evaluación de selección y se muestra dispuesto a cumplir los requisitos del estudio.
    4.2.4.Peso corporal en el momento de selección como se indica a continuación:
    -Cohorte 2 mayor de 15 kg.
    -Cohorte 3 mayor de 10,6 kg.
    -Cohorte 4 mayor de 5 kg.
    4.2.5.Función renal adecuada: filtración glomerular estimada (FGe) >o= 90 ml/min/1,73 m2 según la fórmula de Schwartz
    4.2.6.Función hematológica adecuada, definida como:
    -Recuento absoluto de neutrófilos > 500 células/mm3 (Nota: Los sujetos con neutropenia crónica, definida como un RAN < 500/mm3 documentado al menos dos veces en los 6 meses previos a la selección, y en los que, en opinión del investigador, no haya indicios de una infección grave u oportunista activa podrán participar en el estudio dependiendo de la aprobación del monitor médico de Gilead.)
    -Hemoglobina > 8.5 g/dl (9,5 g/dl en lactantes menores de 35 días de edad).
    -Plaquetas >o= 50.000/mm3.
    4.2.7.Transaminasas hepáticas (ALT y AST) <o= 5 veces el límite superior de la normalidad (LSN).
    4.2.8.Bilirrubina total <o= 1,5 mg/dl o bilirrubina directa normal.
    4.2.10.Resultado negativo en una prueba de embarazo de ß HCG en suero en las mujeres.
    4.2.11.En los sujetos con datos de viremia suprimida (únicamente en la parte A):
    -Concentración plasmática de ARN del VIH 1 (al menos 2 determinaciones consecutivas) en valores indetectables según el análisis utilizado durante al menos 3 meses antes de la selección y ARN del VIH 1 < 50 copias/ml (Roche COBAS TaqMan v2.0) en el momento de selección.
    -Régimen antirretroviral estable, con inclusión de uno de los siguientes IP/r, durante al menos 3 meses antes de la selección: lopinavir/r (Kaletra), atazanavir/r, darunavir/r, tipranavir/r o fosamprenavir/r. Se considerará que los sujetos que se sometan a modificaciones de la dosis del régimen antirretroviral por crecimiento o cambio de la formulación de la medicación se encuentran en un régimen antirretroviral estable.
    4.2.12.En los sujetos que no estén respondiendo al régimen antirretroviral presente en el momento de incorporarse al estudio (partes A y B):
    -ARN del VIH 1 > 1000 copias/ml en el momento de selección (Roche COBAS TaqMan v2.0).
    -Tratamiento previo contra la infección por el VIH 1, definido como 6 meses de tratamiento antirretroviral (a excepción de la cohorte 4, en la que se aceptará un tratamiento inferior a 6 meses), y presencia de al menos una mutación de resistencia documentada, según se define en las directrices actuales de la IAS USA. Estas mutaciones génicas de resistencia deberán encontrarse documentadas en un informe genotípico histórico o en el informe genotípico de selección facilitado por Gilead Sciences.
    -Régimen antirretroviral estable (o ausencia de régimen antirretroviral) durante al menos 30días antes de la selección. Se considerará que los sujetos que se sometan a modificaciones de la dosis del régimen antirretroviral por crecimiento o cambio de la formulación de la medicación se encuentran en un régimen antirretroviral estable.
    -Genotipo de selección con sensibilidad plena a EVG.
    -Posibilidad de elaborar un RB que contenga uno de los siguientes IP/r plenamente activos: lopinavir/r (Kaletra), atazanavir/r, darunavir/r, tipranavir/r o fosamprenavir/r. (?Plenamente activo? se define mediante análisis genotípico.)
    -Puntuación de sensibilidad genotípica (PSG) de al menos 2 (incluido el IP/r plenamente activo y EVG).
    -Ausencia de infecciones oportunistas en los 30 días previos a la incorporación al estudio.
    4.2.13. Los sujetos de ambos sexos en edad fértil deberán comprometerse a utilizar métodos anticonceptivos de gran eficacia durante el tratamiento del estudio o a abstenerse de mantener relaciones heterosexuales durante todo el período del estudio y hasta 30 días después de la última dosis del fármaco del estudio; en los métodos de gran eficacia normalmente se utilizan dos formas diferentes de anticoncepción, una de las cuales ha de ser un método anticonceptivo de barrera eficaz. Las mujeres prepuberales (estadios 1 y 2 de Tanner) no se consideran en edad fértil, a menos que se haya producido la menarquia.
    -Las mujeres que utilicen anticonceptivos hormonales como uno de los métodos anticonceptivos deberán haber utilizado el mismo método durante al menos tres meses antes de la administración del fármaco del estudio. Se recomienda que los anticonceptivos orales contengan un mínimo de 30 µg de etinilestradiol cuando se administren con EVG.
    4.2.14.Disposición y capacidad para cumplir todos los requisitos del estudio.
    E.4Principal exclusion criteria
    Subjects who meet any of the following exclusion criteria are not to be enrolled in this study.

    4.3.1.Subjects with the following CD4+ cell counts:
    -For Cohorts 1 and 2: Screening CD4+ cell count < 50 cells/mm3
    -For Cohort 3: Screening CD4+ cell count < 75 cells/mm3
    -For Cohort 4: Screening CD4+ cell count < 200 cells/mm3

    4.3.2.An acquired immunodeficiency syndrome (AIDS)-defining condition with onset within 30 days prior to screening (refer to Appendix 7)

    4.3.3.Life expectancy of < 1 year

    4.3.4.For subjects with HIV-1 RNA >1,000 copies/mL at screening, prior treatment of any duration with an integrase strand transfer inhibitor.

    4.3.5.An ongoing serious infection requiring systemic antibiotic therapy at the time of screening.

    4.3.6.Evidence of active pulmonary or extra-pulmonary tuberculosis disease:
    -Within 3 months of the Screening visit for all subjects 6 months of age or older
    -At any time for subjects younger than 6 months

    4.3.7.Anticipated requirement for rifamycin treatment while participating in the study. Note: prophylactic isoniazid therapy for latent TB is allowed.

    4.3.8.Have any serious or active medical or psychiatric illness which, in the opinion of the Investigator, would interfere with subject treatment, assessment, or compliance with the protocol. This would include uncontrolled renal, cardiac, hematological, hepatic, pulmonary (including chronic asthma), endocrine (e.g., diabetes), central nervous, gastrointestinal (including an ulcer), vascular, metabolic (thyroid disorders, adrenal disease), immunodeficiency disorders, active infection, or malignancy that are clinically significant or requiring treatment within 30 days prior to the study dosing.

    4.3.9.Subjects experiencing decompensated cirrhosis (eg, ascites, encephalopathy)

    4.3.10.A history of or ongoing malignancy other than cutaneous Kaposi sarcoma (KS), basal cell carcinoma, or resected, non-invasive cutaneous squamous carcinoma. Subjects with biopsy confirmed cutaneous KS are eligible, but must not have received any systemic therapy for KS within 30 days of Baseline and are not anticipated to require systemic therapy during the study.

    4.3.11.Pregnant or lactating subjects.

    4.3.12.Current alcohol or substance abuse judged by the Investigator to potentially interfere with subject compliance.

    4.3.13.Have history of significant drug sensitivity or drug allergy.

    4.3.14.Known hypersensitivity to the investigational medicinal product (IMP), the metabolites, or formulation excipients.

    4.3.15.Have previously participated in an investigational trial involving administration of any investigational agent within 30 days prior to the study dosing.

    4.3.16.Participation in any other clinical trial without prior approval from sponsor is prohibited while participating in this trial.

    4.3.17.Subjects receiving ongoing therapy with any medication that is not to be taken with EVG or a component of the BR, including drugs not to be used with ritonavir (refer to prescribing information for drugs used as part of the BR); examples include the following-see protocol: (Administration of any of the following medications must be discontinued at least 30 days prior to the Baseline/Day 1 visit and for the duration of the study)
    No podrán participar en este estudio los sujetos que cumplan alguno de los criterios de exclusión siguientes.
    4.3.1.Sujetos con los siguientes recuentos de linfocitos CD4+:
    -Cohortes 1 y 2: recuento de linfocitos CD4+ de selección < 50 células/mm3.
    -Cohorte 3: recuento de linfocitos CD4+ de selección < 75 células/mm3.
    -Cohorte 4: recuento de linfocitos CD4+ de selección < 200 células/mm3.
    4.3.2.Enfermedad definitoria de síndrome de inmunodeficiencia adquirida (SIDA) de aparición en los 30 días previos a la selección (véase el apéndice 7).
    4.3.3.Esperanza de vida inferior a un año.
    4.3.4.En los sujetos con un ARN del VIH 1 > 1000 copias/ml en el momento de selección, tratamiento previo de cualquier duración con un inhibidor de la transferencia de cadenas de la integrasa.
    4.3.5.Infección grave en curso con necesidad de administrar antibióticos sistémicos en el momento de selección.
    4.3.6.Datos de tuberculosis pulmonar o extrapulmonar activa:
    -En los 3 meses previos a la visita de selección en todos los sujetos de 6 meses de edad o mayores.
    -En cualquier momento en los sujetos menores de 6 meses.
    4.3.7.Necesidad prevista de tratamiento con rifamicina mientras se participe en el estudio. Nota: Se permite el tratamiento profiláctico con isoniazida por tuberculosis latente.
    4.3.8.Presencia de una enfermedad médica o psiquiátrica grave o activa que, en opinión del investigador, pueda interferir en el tratamiento del sujeto, las evaluaciones o el cumplimiento del protocolo. Entre ellas figuran enfermedades renales, cardíacas, hematológicas, hepáticas, pulmonares (incluida el asma crónica), endocrinas (por ejemplo, diabetes), del sistema nervioso central, digestiva (incluida una úlcera), vasculares, metabólicas (trastornos tiroideos, enfermedad suprarrenal), inmunodeficiencias, infecciones o neoplasias malignas no controladas que tengan importancia clínica o precisen tratamiento en los 30 días previos a la administración de la medicación del estudio.
    4.3.9.Presencia de cirrosis descompensada (por ejemplo, ascitis o encefalopatía).
    4.3.10.Antecedentes o presencia de una neoplasia maligna distinta de un sarcoma de Kaposi (SK) cutáneo, carcinoma basocelular o carcinoma espinocelular cutáneo no invasivo y resecado. Los sujetos con SK cutáneo confirmado mediante biopsia podrán participar, pero no podrán haber recibido un tratamiento sistémico contra el SK en los 30 días previos a la visita basal ni deberá preverse que necesiten tratamiento sistémico durante el estudio.
    4.3.11.Mujeres embarazadas o en período de lactancia.
    4.3.12.Abuso de alcohol o sustancias presente que, según el criterio del investigador, podría afectar al cumplimiento del sujeto.
    4.3.13.Antecedentes de sensibilidad o alergia a los fármacos significativa.
    4.3.14.Hipersensibilidad conocida al producto en investigación (PEI), sus metabolitos o los excipientes de la formulación.
    4.3.15.Participación previa en un estudio de investigación con administración de cualquier fármaco en investigación en los 30 días previos a la administración de la medicación del estudio.
    4.3.16.Durante la participación en este estudio queda prohibida la participación en otros ensayos clínicos sin la aprobación previa del promotor.
    4.3.17.Tratamiento activo con cualquier medicamento que no pueda tomarse con EVG o con un componente del RB, incluidos los medicamentos que no deban utilizarse con ritonavir (véase la ficha técnica de los fármacos utilizados como parte del RB); algunos ejemplos son los siguientes: (la administración de cualquiera de los medicamentos siguientes deberá suspenderse al menos 30 días antes de la visita basal/día 1 y durante la totalidad del estudio)
    E.5 End points
    E.5.1Primary end point(s)
    The primary endpoints of this study are Pharmacokinetic (PK) parameters AUCtau and Cmax of EVG and the incidence of treatment-emergent AEs and treatment-emergent laboratory abnormalities
    Los criterios de valoración principales de este estudio son:
    -Parámetros FC AUCtau y Cmáx de EVG.
    -Incidencia de AA y anomalías analíticas de aparición durante el tratamiento.
    E.5.1.1Timepoint(s) of evaluation of this end point
    Pharmacokinetic (PK) parameters AUCtau and Cmax of EVG- timepoint of evaluation Day 10

    Incidence of treatment-emergent AEs and treatment-emergent laboratory abnormalities- timepoint through to week 48
    -Parámetros FC AUCtau y Cmáx de EVG- evaluación en el día 10
    -Incidencia de AA y anomalías analíticas de aparición durante el tratamiento- evaluación en la semana 48
    E.5.2Secondary end point(s)
    The secondary endpoints of this study are:

    -PK parameters Ctau, CL/F, and Vz/F of EVG
    -The percentage of subjects with plasma HIV 1 RNA <50 and <400 copies/mL at Weeks 24 and 48 as defined by the FDA snapshot analysis, respectively
    -The change from baseline in plasma log10 HIV 1 RNA (copies/mL), in CD4+ cell count (cells/?L), and CD4 percentage at Weeks 24 and 48
    -Tanner Stages at Weeks 24 and 48, and age of first menses.
    -Palatability of oral suspension formulation of EVG in appropriate age group
    -Adherence to EVG
    Los criterios de valoración secundarios de este estudio son:
    -Parámetros FC Ctau, CL/F y Vz/F de EVG.
    -Porcentaje de sujetos con un ARN del VIH 1 en plasma < 50 y < 400 copias/ml en las semanas 24 y 48, respectivamente, según lo definido mediante el análisis instantáneo de la FDA.
    -Variación con respecto al momento basal del log10 ARN del VIH 1 en plasma (copias/ml), el recuento de linfocitos CD4+ (células/µl) y el porcentaje de linfocitos CD4+ en las semanas 24 y 48.
    -Estadios de Tanner en las semanas 24 y 48 y edad de la primera menstruación.
    -Palatabilidad de la formulación en suspensión oral de EVG en el grupo de edad apropiado.
    -Cumplimiento del tratamiento con EVG.
    E.5.2.1Timepoint(s) of evaluation of this end point
    Timepoint(s) of evaluation are;

    -PK parameters Ctau, CL/F, and Vz/F of EVG- timepoint Day 10
    -The percentage of subjects with plasma HIV 1 RNA <50 and <400 copies/mL at Weeks 24 and 48 as defined by the FDA snapshot analysis, respectively
    -The change from baseline in plasma log10 HIV 1 RNA (copies/mL), in CD4+ cell count (cells/?L), and CD4 percentage at Weeks 24 and 48
    -Tanner Stages at Weeks 24 and 48, and age of first menses.
    -Palatability of oral suspension formulation of EVG in appropriate age group- through to week 48
    -Adherence to EVG- through to week 48
    Los criterios de valoración secundarios de este estudio son:
    -Parámetros FC Ctau, CL/F y Vz/F de EVG.-evaluación en día 10
    -Porcentaje de sujetos con un ARN del VIH 1 en plasma < 50 y < 400 copias/ml en las semanas 24 y 48, respectivamente, según lo definido mediante el análisis instantáneo de la FDA.
    -Variación con respecto al momento basal del log10 ARN del VIH 1 en plasma (copias/ml), el recuento de linfocitos CD4+ (células/µl) y el porcentaje de linfocitos CD4+ en las semanas 24 y 48.
    -Estadios de Tanner en las semanas 24 y 48 y edad de la primera menstruación.
    -Palatabilidad de la formulación en suspensión oral de EVG en el grupo de edad apropiado.-en la semana 48
    -Cumplimiento del tratamiento con EVG.-en la semana 48
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) Yes
    E.7.3Therapeutic confirmatory (Phase III) Yes
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled No
    E.8.1.1Randomised No
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group No
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial1
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned3
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA13
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA No
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    France
    Germany
    Italy
    Mexico
    South Africa
    Spain
    Thailand
    Uganda
    United Kingdom
    E.8.7Trial has a data monitoring committee Yes
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    Part A subjects with suppressed viremia, the end of study is defined as the completion of Day 10 & the 30-Day Follow-up visit.
    For subjects failing a current antiretroviral regimen, the end of study is defined as the completion of 48 weeks on study drug & the 30-Day Follow-up visit.
    For extension phase end of trial is when a) subject turns 18 & EVG is available for use in adults or b) the age appropriate EVG formulation becomes available or c) Sponsor elects to terminate development of EVG.
    Para los sujetos de la parte A con viremia suprimida, final de las visitas de seguimiento del día 10 y 30.Para los pacientes que no cumplan un regimen de tratamiento antirretroviral,final de las 48 semanas del medicamento en estudio y la visita de seguimiento del día 30.Para la fase de extensión, cuando a) el sujeto cumple 18 y EVG está disponible para uso en adultos o b) la edad apropiada en la que la formulación de EVG está disponible o c) el promotor decide acabar con el desarrollo de EVG.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years2
    E.8.9.1In the Member State concerned months11
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years2
    E.8.9.2In all countries concerned by the trial months11
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 Yes
    F.1.1Number of subjects for this age range: 86
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) Yes
    F.1.1.4.1Number of subjects for this age range: 20
    F.1.1.5Children (2-11years) No
    F.1.1.5.1Number of subjects for this age range: 52
    F.1.1.6Adolescents (12-17 years) No
    F.1.1.6.1Number of subjects for this age range: 14
    F.1.2Adults (18-64 years) No
    F.1.3Elderly (>=65 years) No
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception No
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally Yes
    F.3.3.6.1Details of subjects incapable of giving consent
    Paediatric patients aged 4weeks to >18years
    Pacientes pediátricos entre edades de 4 semanas a < de 18 años
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state4
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 15
    F.4.2.2In the whole clinical trial 86
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    After Week 48, all subjects receiving EVG will be given the option to participate in an extension phase of the study where Gilead will provide EVG until: a) the subject turns 18 and EVG is available for use in adults in the country in which the subject is enrolled or b) the age appropriate EVG formulation becomes available for use in the country in which the subject is enrolled or c) Gilead Sciences elects to terminate development of EVG in the applicable country.
    Después de la semana 48, todos los pacientes que reciben EVG se les dará la opción de participar en una fase de extensión del estudio donde Gilead les dará EVG hasta: a) que el sujeto cumpla 18 y EVG esté disponible para usarse en adultos en el país en el que el sujeto está participando o b) la edad apropiada para la que la formulación EVG esté disponible en el pais en el que el sujeto está participando o c) Gilead Sciences elija acabar con el desarrollo de EVG en el país aplicable
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2013-11-21
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2013-11-11
    P. End of Trial
    P.End of Trial StatusCompleted
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