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    Clinical Trial Results:
    Evaluation of the pharmacokinetic properties and the tolerance of raltegravir during the third trimester of pregnancy

    Summary
    EudraCT number
    2013-004571-12
    Trial protocol
    FR  
    Global end of trial date
    31 Jan 2017

    Results information
    Results version number
    v1(current)
    This version publication date
    08 Mar 2024
    First version publication date
    08 Mar 2024
    Other versions
    Summary report(s)
    Summary of final report ANRS RalFE

    Trial information

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    Trial identification
    Sponsor protocol code
    ANRS 160 Ralfe
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT02099474
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Inserm-ANRS
    Sponsor organisation address
    101 rue de Tolbiac, Paris, France, 75013
    Public contact
    Jade Ghosn, CHU Hôtel Dieu, +33 1 42 34 88 52, jade.ghosn@htd.aphp.fr
    Scientific contact
    Jade Ghosn, CHU Hôtel Dieu, +33 1 42 34 88 52, jade.ghosn@htd.aphp.fr
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    30 Apr 2017
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    31 Jan 2017
    Global end of trial reached?
    Yes
    Global end of trial date
    31 Jan 2017
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To study pharmacokinetic properties of raltegravir in pregnant women infected by HIV-1, during the third trimester of pregnancy (between 30 and 37 weeks of amenorrhoea) and 1 month after childbirth (between W4 and W6 post-partum), as well as in their neonate.
    Protection of trial subjects
    This study is conducted in accordance with the updated Declaration of Helsinki, in compliance with the approved protocol and its amendments, the International Council for Harmonisation guideline for Good Clinical Practice (ICH GCP) and French regulatory requirements.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    30 Jun 2014
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    France: 43
    Worldwide total number of subjects
    43
    EEA total number of subjects
    43
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    43
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    From June 2014 to May 2016, 45 participants were screened from 12 sites (2 maternity and 10 departments of infectious disease or internal medicine).

    Pre-assignment
    Screening details
    Main criteria for the expecting mothers: Inclusion: pregnant women at least 18 years old, between W30 and W37 of amenorrhoea, infected by HIV-1. Non-inclusion: under 18 years old, infected by HIV-2. Main criteria for the pharmacologic study in neonates: Inclusion: mother included in the study, weight >=1000kg. Non-inclusion: weight <1000k.

    Period 1
    Period 1 title
    Overall trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Arm title
    RalFE arm
    Arm description
    -
    Arm type
    Experimental

    Investigational medicinal product name
    Raltégravir
    Investigational medicinal product code
    Other name
    Isentress®
    Pharmaceutical forms
    Film-coated tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Dosage of 400mg twice a day.

    Number of subjects in period 1
    RalFE arm
    Started
    43
    Completed
    42
    Not completed
    1
         Consent withdrawn by subject
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    RalFE arm
    Reporting group description
    -

    Reporting group values
    RalFE arm Total
    Number of subjects
    43 43
    Age categorical
    Units: Subjects
        In utero
    0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0
        Newborns (0-27 days)
    0 0
        Infants and toddlers (28 days-23 months)
    0 0
        Children (2-11 years)
    0 0
        Adolescents (12-17 years)
    0 0
        Adults (18-64 years)
    43 43
        From 65-84 years
    0 0
        85 years and over
    0 0
    Age continuous
    Units: years
        median (inter-quartile range (Q1-Q3))
    33 (29 to 38) -
    Gender categorical
    Units: Subjects
        Female
    43 43
        Male
    0 0

    End points

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    End points reporting groups
    Reporting group title
    RalFE arm
    Reporting group description
    -

    Primary: Pharmacokinetic properties of raltegravir in pregnant women

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    End point title
    Pharmacokinetic properties of raltegravir in pregnant women [1]
    End point description
    The principal objective of this trial is to study pharmacokinetic properties of raltegravir in pregnant women infected by HIV-1, during the third trimester of pregnancy (between 30 and 37 weeks of amenorrhoea) and 1 month after childbirth (between 4 and 6 weeks post-partum), as well as in their neonates.
    End point type
    Primary
    End point timeframe
    Pharmacokinetic study conducted twice, once between W30 and W37 of amenorrhoea and once between W4 and W6 post-partum.
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: This endpoint concerns a single arm, adding statistical analyses create errors. See attachment for additional informations.
    End point values
    RalFE arm
    Number of subjects analysed
    43
    Units: concentration
        number (not applicable)
    43
    Attachments
    RalFE article
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    From 30-Jun-2014 to 30-Apr-2017
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    18.1
    Reporting groups
    Reporting group title
    Raltegravir
    Reporting group description
    All women have been prescribed raltegravir before study participation. 17 subjects were affected by serious adverse events: 8 mothers and 9 children.

    Serious adverse events
    Raltegravir
    Total subjects affected by serious adverse events
         subjects affected / exposed
    17 / 43 (39.53%)
         number of deaths (all causes)
    0
         number of deaths resulting from adverse events
    0
    Injury, poisoning and procedural complications
    overdose
    Additional description: Neonate Serious Adverse Event
         subjects affected / exposed
    1 / 43 (2.33%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    skull fracture
    Additional description: Neonate Serious Adverse Event
         subjects affected / exposed
    1 / 43 (2.33%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    subdural haematoma
    Additional description: Neonate Serious Adverse Event
         subjects affected / exposed
    1 / 43 (2.33%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Congenital, familial and genetic disorders
    brachydactyly
    Additional description: Neonate Serious Adverse Event
         subjects affected / exposed
    1 / 43 (2.33%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    enteric duplication
    Additional description: Neonate Serious Adverse Event
         subjects affected / exposed
    1 / 43 (2.33%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    congenital genitourinary abnormality
    Additional description: Neonate Serious Adverse Event
         subjects affected / exposed
    1 / 43 (2.33%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    polydactyly
    Additional description: Neonate Serious Adverse Event
         subjects affected / exposed
    1 / 43 (2.33%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    renal aplasia
    Additional description: renal agenesis with pericardial effusion diagnosed during pregnancy
         subjects affected / exposed
    1 / 43 (2.33%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cardiac disorders
    pericardial effusion
    Additional description: renal agenesis with pericardial effusion diagnosed during pregnancy
         subjects affected / exposed
    1 / 43 (2.33%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Nervous system disorders
    subarachnoid haemorrhage
    Additional description: Neonate Serious Adverse Event
         subjects affected / exposed
    1 / 43 (2.33%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pregnancy, puerperium and perinatal conditions
    foetal growth restriction
         subjects affected / exposed
    1 / 43 (2.33%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    foetal heart rate disorder
         subjects affected / exposed
    2 / 43 (4.65%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    poor weight gain neonatal
    Additional description: Neonate Serious Adverse Event
         subjects affected / exposed
    1 / 43 (2.33%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    gestational diabetes
         subjects affected / exposed
    1 / 43 (2.33%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    foetal malnutrition
    Additional description: Neonate Serious Adverse Event
         subjects affected / exposed
    1 / 43 (2.33%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    pre-eclampsia
         subjects affected / exposed
    1 / 43 (2.33%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    premature baby
    Additional description: Neonate Serious Adverse Event
         subjects affected / exposed
    1 / 43 (2.33%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    vomiting in pregnancy
         subjects affected / exposed
    1 / 43 (2.33%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Blood and lymphatic system disorders
    microcytic anaemia
         subjects affected / exposed
    1 / 43 (2.33%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    General disorders and administration site conditions
    general physical health deterioration
         subjects affected / exposed
    1 / 43 (2.33%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal disorders
    gastrooesophageal reflux disease
    Additional description: Neonate Serious Adverse Event
         subjects affected / exposed
    1 / 43 (2.33%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hepatobiliary disorders
    cholestasis of pregnancy
         subjects affected / exposed
    1 / 43 (2.33%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    hepatocellular injury
         subjects affected / exposed
    1 / 43 (2.33%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    hyperbilirubinaemia neonatal
    Additional description: Neonate Serious Adverse Event
         subjects affected / exposed
    1 / 43 (2.33%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    abdominal wall abscess
         subjects affected / exposed
    1 / 43 (2.33%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    oral fungal infection
    Additional description: Neonate Serious Adverse Event
         subjects affected / exposed
    1 / 43 (2.33%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    pyelonephritis acute
    Additional description: Neonate Serious Adverse Event
         subjects affected / exposed
    1 / 43 (2.33%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Raltegravir
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    39 / 43 (90.70%)
    Vascular disorders
    hypertension arterial
         subjects affected / exposed
    3 / 43 (6.98%)
         occurrences all number
    0
    Pregnancy, puerperium and perinatal conditions
    false labour
         subjects affected / exposed
    4 / 43 (9.30%)
         occurrences all number
    0
    fœtal growth restriction
         subjects affected / exposed
    2 / 43 (4.65%)
         occurrences all number
    0
    pre-eclampsia
         subjects affected / exposed
    3 / 43 (6.98%)
         occurrences all number
    0
    gestational diabetes
         subjects affected / exposed
    6 / 43 (13.95%)
         occurrences all number
    0
    Blood and lymphatic system disorders
    anaemia
         subjects affected / exposed
    4 / 43 (9.30%)
         occurrences all number
    0
    Gastrointestinal disorders
    vomiting
         subjects affected / exposed
    3 / 43 (6.98%)
         occurrences all number
    0
    Infections and infestations
    gastroenteritis
    Additional description: Neonate Serious Adverse Event
         subjects affected / exposed
    5 / 43 (11.63%)
         occurrences all number
    0
    nasopharyngitis
    Additional description: Neonate Serious Adverse Event
         subjects affected / exposed
    5 / 43 (11.63%)
         occurrences all number
    0
    oral candidiasis
    Additional description: Neonate Serious Adverse Event
         subjects affected / exposed
    3 / 43 (6.98%)
         occurrences all number
    0
    vaginal infection
         subjects affected / exposed
    8 / 43 (18.60%)
         occurrences all number
    0
    vulvovaginal mycotic infection
         subjects affected / exposed
    4 / 43 (9.30%)
         occurrences all number
    0

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    10 Jul 2015
    The substantial modifications included in the Amendment 1 of the protocol are: - Update of the centres' list and main investigators. - Modification of authorized range to carry out the pre-inclusion visit: between W28 and W37 of amenorrhoea.
    18 Dec 2015
    The substantial modifications included in Amendment 2 of the protocol are: - Extension of the enrolment period and modification of the number of participants to include.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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