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    Summary
    EudraCT Number:2014-005147-40
    Sponsor's Protocol Code Number:201636
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Completed
    Date on which this record was first entered in the EudraCT database:2021-06-08
    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 ConcernedItaly - Italian Medicines Agency
    A.2EudraCT number2014-005147-40
    A.3Full title of the trial
    A Phase III, randomized, multicenter, parallel-group, noninferiority study evaluating the efficacy, safety, and tolerability of switching to dolutegravir plus rilpivirine from current INI-, NNRTI-, or PI-based antiretroviral regimen in HIV-1-infected adults who are virologically suppressed
    Studio di non inferiorit¿ di fase III, multicentrico, randomizzato, a gruppi paralleli volto a valutare l¿efficacia, la sicurezza e la tollerabilit¿ del passaggio a dolutegravir pi¿ rilpivirina dall¿attuale regime antiretrovirale con INI, NNRTI o PI in adulti con infezione da HIV-1 in soppressione virologica
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Phase III, randomized, multicenter, parallel-group, noninferiority study evaluating the efficacy, safety, and tolerability of switching to dolutegravir plus rilpivirine from current INI-, NNRTI-, or PI-based antiretroviral regimen in HIV-1-infected adults who are virologically suppressed
    Studio di non inferiorit¿ di fase III, multicentrico, randomizzato, a gruppi paralleli volto a valutare l¿efficacia, la sicurezza e la tollerabilit¿ del passaggio a dolutegravir pi¿ rilpivirina dall¿attuale regime antiretrovirale con INI, NNRTI o PI in adulti con infezione da HIV-1 in soppressione virologica
    A.3.2Name or abbreviated title of the trial where available
    SWORD-1
    SWORD-1
    A.4.1Sponsor's protocol code number201636
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorVIIV HEALTHCARE UK LIMITED
    B.1.3.4CountryUnited Kingdom
    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 supportViiV Healthcare UK (No.3) Limited
    B.4.2CountryUnited Kingdom
    B.4.1Name of organisation providing supportJanssen Sciences Ireland UC
    B.4.2CountryIreland
    B.4.1Name of organisation providing supportGlaxoSmithKline Research and Development Ltd.
    B.4.2CountryUnited Kingdom
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationGlaxoSmithKline Research & Development Ltd
    B.5.2Functional name of contact pointClinical Trials HelpDesk
    B.5.3 Address:
    B.5.3.1Street AddressIron Bridge Road
    B.5.3.2Town/ cityUxbridge
    B.5.3.3Post codeUB11 1BU
    B.5.3.4CountryUnited Kingdom
    B.5.4Telephone number800786766
    B.5.5Fax number+44 208 990 1234
    B.5.6E-mailGSKClinicalSupportHD@gsk.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 Yes
    D.2.1.1.1Trade name TIVICAY - 50 MG - COMPRESSA RIVESTITA CON FILM - USO ORALE - FLACONE (HDPE) - 30 COMPRESSE
    D.2.1.1.2Name of the Marketing Authorisation holderVIIV HEALTHCARE BV
    D.2.1.2Country which granted the Marketing AuthorisationItaly
    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 nameDolutegravir
    D.3.2Product code GSK1349572
    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 INNDOLUTEGRAVIR
    D.3.9.1CAS number 1051375-19-9
    D.3.9.2Current sponsor codeGSK1349572
    D.3.9.3Other descriptive nameSodium (4R,9aS)-5-Hydroxy-4-methyl-6,10-dioxo-3,4,6,9,9a,10-hexahydro-2H-1-oxa- 4a,8a-diaza-anthracene-7-carboxylic acid 2,4-difluoro-benzylamide
    D.3.9.4EV Substance CodeSUB31300
    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 Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    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 Yes
    D.2.1.1.1Trade name EDURANT - 25 MG - COMPRESSA RIVESTITA CON FILM - USO ORALE - FLACONE (HDPE) 30 COMPRESSE
    D.2.1.1.2Name of the Marketing Authorisation holderJANSSEN-CILAG INTERNATIONAL N.V.
    D.2.1.2Country which granted the Marketing AuthorisationItaly
    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 nameRilpivirine
    D.3.2Product code EDURANT
    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 INNRILPIVIRINE HYDROCHLORIDE
    D.3.9.1CAS number 700361-47-3
    D.3.9.2Current sponsor codenon disponibile
    D.3.9.3Other descriptive nameR314585, TMC278, JNJ-16150108-AAC
    D.3.9.4EV Substance CodeSUB31460
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number25
    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 Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    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 type 1 (HIV-1)
    Virus dell'immunodeficienza umana di tipo 1 (HIV-1)
    E.1.1.1Medical condition in easily understood language
    Human immunodeficiency virus type 1 (HIV-1)
    Virus dell'immunodeficienza umana di tipo 1 (HIV-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 20.1
    E.1.2Level LLT
    E.1.2Classification code 10003582
    E.1.2Term Asymptomatic human immunodeficiency virus type I infection
    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
    To demonstrate the non-inferior antiviral activity of switching to dolutegravir (DTG) plus rilpivirine (RPV) once daily compared to continuation of current antiretroviral regimen (CAR) over 48 weeks in
    HIV-1 infected antiretroviral therapy (ART)-experienced subjects.
    Dimostrare la non inferiorit¿ dell¿attivit¿ antivirale dello switch a dolutegravir (DTG) pi¿ rilpivirina (RPV) in monosomministrazione giornaliera rispetto alla prosecuzione dell¿attuale regime antiretrovirale (CAR) nel corso di 48 settimane in soggetti con infezione da HIV-1 gi¿ trattati con ART
    E.2.2Secondary objectives of the trial
    * To evaluate the immunological activity of DTG + RPV once daily compared to continuation of CAR.
    * To evaluate the antiviral activity of DTG + RPV once daily compared to continuation of CAR.
    * To evaluate the safety and tolerability of DTG + RPV once daily compared to continuation of CAR over time.
    * To evaluate renal (in urine and blood), bone (in blood), and cardiovascular biomarkers (in blood) in subjects treated with DTG + RPV compared to continuation of CAR.
    * To evaluate the effects of DTG + RPV once daily on fasting lipids over time compared to continuation of CAR.
    * To assess viral resistance in subjects meeting Virologic Withdrawal Criteria.
    * To evaluate DTG and RPV trough concentrations.
    * To evaluate the DTG and RPV trough concentrations over time during the initial post-switch period in the first 20 subjects who switch from EFV or NVP to DTG + RPV.
    REFER TO PROTOCOL (page 18, section3) FOR COMPLETE LIST SECONDARY OBJECTIVES.
    ¿Valutare l¿attivit¿ immunologica di DTG + RPV in monosomministrazione giornaliera, rispetto alla prosecuzione del CAR ¿Valutare l¿attivit¿ antivirale di DTG + RPV in monosomministrazione giornaliera, rispetto alla prosecuzione del CAR ¿Valutare la sicurezza e la tollerabilit¿ di DTG + RPV in monosomministrazione giornaliera, rispetto alla prosecuzione del CAR nel corso del tempo
    ¿Valutare i biomarcatori renali (in sangue e urine), ossei (nel sangue) e cardiovascolari (nel sangue) in soggetti trattati con DTG + RPV rispetto alla continuazione del CAR ¿Valutare gli effetti nel tempo di DTG + RPV in monosomministrazione giornaliera sui lipidi a digiuno rispetto alla prosecuzione del CAR
    ¿Valutare la resistenza virale in soggetti che soddisfano i criteri di ritiro virologico (ritiro dallo studio per fallimento virologico) ¿Valutare le concentrazioni minime di DTG e RPV nel corso del tempo durante il periodo iniziale post-switch, nei primi 20 soggetti che passano da EFV o NVP a DTG + RPV
    E.2.3Trial contains a sub-study Yes
    E.2.3.1Full title, date and version of each sub-study and their related objectives

    Pharmacogenetics
    Version: 01(2014N208737_01)
    Date: 26/02/2015
    Title: Genetic Research
    Objectives: The objectives of the genetic research are to investigate a relationship between genetic variants and:
    - Response to medicine, including DTG + RPV or any concomitant medicines;
    - HIV-1 susceptibility, severity and progression and related conditions.

    Farmacogenetica
    Versione: 01(2014N208737_01)
    Data: 26/02/2015
    Titolo: Ricerca Genetica
    Obiettivi: Nell¿ambito dello studio 201636 verr¿ eseguita una ricerca genetica con l¿obiettivo di studiare l¿influenza di varianti genetiche:
    ¿sulla risposta al farmaco, compreso DTG + RPV o qualsiasi altro farmaco concomitante;
    ¿sulla suscettibilit¿, gravit¿ e progressione di HIV-1 e condizioni correlate.


    E.3Principal inclusion criteria
    1. HIV-1 infected men or women =18 years of age;
    2. Must be on uninterrupted current regimen (either the initial or second cART regimen)for at least 6 months prior to Screening. Any prior switch, defined as a change of a single drug or multiple drugs simultaneously, must have occurred due to tolerability
    and/or safety concerns or access to medications, or convenience/simplification.
    Acceptable stable cART regimens prior to Screening include 2 NRTIs plus:
    •INI (either the initial or second cART regimen)
    •NNRTI (either the initial or second cART regimen)
    •Boosted PI (or atazanavir [ATV] unboosted) (either the initial or second PI-based cART
    regimen).
    3. Documented evidence of at least two plasma HIV-1 RNA measurements <50 c/mL in the 12 months prior to Screening: one within the 6 to 12 month window, and one within 6 months prior to Screening;
    4. Plasma HIV-1 RNA <50 c/mL at Screening;
    5. A female, may be eligible to enter and participate in the study if she:
    a. is of non-child-bearing potential either defined as post-menopausal (12 months of spontaneous amenorrhea and =45 years of age) or physically incapable of becoming pregnant with documented tubal ligation, hysterectomy or bilateral oophorectomy or,
    b. is of child-bearing potential with a negative pregnancy test at both Screening and Day 1 and agrees to use one of the following methods of contraception to avoid pregnancy:
    - Complete abstinence from intercourse from 2 weeks prior to administration of study drug, throughout the study, and for at least 2 weeks after discontinuation of all study medications and completion of the Follow-up visit
    - Any intrauterine device (IUD) with published data showing that the expected failure rate is <1% per year (not all IUDs meet this criterion, see the SPM for a listing describing criteria of approved IUDs);
    - Male partner sterilization with documentation of azoospermia prior to the female subject's entry into the study and this male is the sole partner for that subject;
    [Hatcher, 2011]. The documentation on male sterility can come from the site personnel's review of subject's medical records, medical examination, and/or semen analysis, or medical history interview provided by her or her partner.
    - Approved hormonal contraception for subjects randomly assigned to DTG + RPV arm (and for subjects randomly assigned to CAR following switch to DTG + RPV at Week 52) or approved hormonal contraception plus a barrier method for subjects assigned to CAR through Week 52 (see the SPM for a listing of examples of approved hormonal contraception). Approved hormonal contraception
    includes:
    -Combined estrogen and progestogen oral contraceptive
    [Hatcher,2011])
    -Contraceptive subdermal implant
    -Injectable progestogen [Hatcher, 2011]
    -Contraceptive vaginal ring [Hatcher, 2011]
    -Percutaneous contraceptive patches [Hatcher, 2011]
    - Any other method with published data showing that the expected failure rate is <1% per
    year.
    Any contraception method must be used consistently, in accordance with the approved product label during treatment with study drug and for at least 2 weeks after discontinuation of study drug and completion of the Follow-Up Visit. The investigator is responsible for ensuring that subjects understand how to properly use these methods of contraception. Periodic abstinence (e.g. calendar,
    ovulation, symptothermal, postovulation methods) and withdrawal are not acceptable methods of contraception. Note: these contraceptive requirements do not apply to females of reproductive potential with same sex partners only, when this is their preferred and usual lifestyle.
    All subjects participating in the study should be counseled on safer sexual practices including the use and benefit/risk of effective barrier methods (e.g., male condom) and on the risk of HIV transmission to an uninfected partner.
    6. Subject is willing and able to understand requirements of study participation and provide signed and dated written informed consent prior to Screening.
    1. Donne o uomini con infezione da HIV-1 di età =18 anni
    2. Attuale regime di trattamento (prima o seconda terapia di combinazione antiretrovirale (cART) che prosegue ininterrotto da almeno 6 mesi prima dello screening).
    Le cART stabili accettabili prima dello screening comprendono 2 NRTI più: • INI (nella prima o nella seconda cART) • NNRTI (nella prima o nella seconda cART) • PI potenziato (o atazanavir [ATV] non potenziato) (prima o seconda cART a base di PI). 3. Evidenza documentata di almeno 2 misurazioni dei livelli di HIV-1 RNA <50 c/mL nei 12 mesi precedenti lo screening: una da 6 a 12 mesi da 0 a 6 mesi prima dello screening. 4. Livelli plasmatici di HIV-1 RNA <50 c/mL allo screening.
    5. Le donne sono eleggibili se:
    a) non sono potenzialmente fertili, in quanto in post-menopausa (12 mesi di amenorrea spontanea ed età =45 anni) o non in grado di intraprendere una gravidanza per legatura delle tube, isterectomia o ovariectomia bilaterale documentate, oppure
    b) sono potenzialmente fertili ma presentano un test di gravidanza negativo sia allo screening sia al giorno 1 e acconsentono a utilizzare uno dei seguenti metodi contraccettivi:
    • astinenza completa da rapporti sessuali a partire da 2 weeks prima della somministrazione del prodotto sperimentale (IP), durante tutto lo studio e per almeno 2 weeks dopo l’interruzione del trattamento con tutti i farmaci in studio e del
    completamento della visita di Follow up;
    • qualsiasi dispositivo intrauterino (IUD) su cui vi siano dati pubblicati che dimostrino un tasso di fallimento <1% annuo (non tutti gli IUD soddisfano questo requisito;
    • sterilizzazione del partner maschile, con azoospermia documentata precedente all’ entrata nello studio del soggetto femminile, laddove tale partner sia l’unico. La documentazione sulla sterilità del partner maschile può derivare dalla revisione della documentazione medica del soggetto da parte dello staff dello studio, dall'esame medico e/o dall'analisi del liquido seminale, o dall'intervista sulla storia medica fornita dalla paziente o dal suo partner.
    • metodo contraccettivo ormonale approvato per i soggetti randomizzati al braccio DTG + RPV (e per i soggetti che sono stati assegnati tramite randomizzazione a CAR in seguito al passaggio a DTG + RPV alla settimana 52) o metodo contraccettivo ormonale approvato più un metodo di barriera per i soggetti assegnati a proseguire CAR fino alla week 52 (per alcuni esempi di metodi contraccettivi ormonali approvati, si rimanda all’ SPM). La contraccezione ormonale approvata comprende: • Contraccettivo orale stroprogestinico combinato • Impianto contraccettivo sottocutaneo • Progesterone iniettabile • Anello vaginale anticoncezionale • Cerotti anticoncezionali percutanei • qualsiasi altro metodo con dati pubblicati che dimostrino un tasso di fallimento <1% annuo. Tutti i metodi di contraccezione devono essere utilizzati in modo continuativo, nel rispetto della scheda tecnica approvata, durante tutto il trattamento con il farmaco
    sperimentale e per almeno 2 settimane dopo l’interruzione del trattamento con il farmaco in studio e completamento della visita di follow-up. Lo sperimentatore è responsabile di assicurarsi che i soggetti comprendano come usare correttamente questi metodi contraccettivi. L'astinenza periodica (ad esempio il calendario, l'ovulazione, i metodi sintotermici, post-ovulazione) e la rinuncia non sono metodi contraccettivi accettabili.
    Nota: queste prescrizioni anticoncezionali non si applicano alle donne potenzialmente fertili con partner dello stesso sesso, quando questo è il loro stile di vita preferito e abituale.
    6. Volontà e capacità del soggetto di comprendere i requisiti per la partecipazione allo studio e di fornire il proprio consenso informato scritto, firmato e datato, prima dello screening.
    E.4Principal exclusion criteria
    A subject will not be eligible for inclusion in this study if any of the following criteria apply:
    Exclusionary Criteria prior to Screening or Day 1
    1. Within 6 months prior to Screening and after confirmed suppression to <50 c/mL on current ART regimen, any plasma HIV-1 RNA measurement >=50 c/mL;
    2. Within the 6 to 12 month window prior to Screening and after confirmed suppression to <50 c/mL, any plasma HIV-1 RNA measurement >200 c/mL;
    3. Within the 6 to 12 month window prior to Screening and after confirmed suppression to <50 c/mL, 2 or more plasma HIV-1 RNA measurements >=50 c/mL;
    4. Any drug holiday during the window between initiating first HIV ART and 6 months prior to Screening, except for brief periods (less than 1
    month) where all ART was stopped due to tolerability and/or safety concerns;
    5. Any switch to a second line regimen, defined as change of a single drug or multiple drugs simultaneously, due to virologic failure to therapy
    (defined as a confirmed plasma HIV-1 RNA measurement > or = 400 c/mL after initial suppression to <50 c/mL while on first line HIV
    therapy regimen);
    Exclusionary medical conditions
    7. Any evidence of an active Centers for Disease Control and Prevention (CDC) Category C disease. Exceptions include cutaneous Kaposi's sarcoma not requiring systemic therapy and historic CD4+ lymphocyte counts of <200 cells/mm3;
    8. Subjects with severe hepatic impairment (Class C) as determined by Child-Pugh Classification C Appendix 2 of study Protocol, p97);
    13. Ongoing malignancy other than cutaneous Kaposi's sarcoma, basal cell carcinoma, or resected, non-invasive cutaneous squamous cell
    carcinoma, or cervical intraepithelial neoplasia; other localized malignancies require agreement between the investigator and the Study Medical Monitor
    for inclusion of the subject prior to randomization;
    14. Subjects who in the investigator's judgment pose a significant suicidality risk. Subject's history of suicidal behavior and/or suicidal ideation should be considered when evaluating for suicide risk;
    Exclusionary Treatments prior to Screening or Day 1
    18. Treatment with an HIV-1 immunotherapeutic vaccine within 90 days of Screening;
    19. Treatment with any of the following agents within 28 days of Screening: radiation therapy; cytotoxic chemotherapeutic agents; any
    immunomodulators that alter immune responses (a list of examples is provided in the SPM);
    20. Exposure to an experimental drug or experimental vaccine within either 28 days, 5 half-lives of the test agent, or twice the duration of the
    biological effect of the test agent, whichever is longer, prior to Day 1 of this study **Please refer to study Protocol 201636, for continuing list of the Exclusion Criteria**
    Un soggetto non risulterà eleggibile per l’inclusione nello studio se risponde a uno qualsiasi dei criteri elencati di seguito. Condizioni di esclusione precedenti lo screening o il giorno 1
    1.Nei 6 mesi precedenti lo screening e dopo la conferma della soppressione virologica a livelli <50 c/mL ottenuta con l’attuale terapia antiretrovirale, qualsiasi misurazione dei livelli plasmatici di HIV-1 RNA >=50 c/mL. - 2.Nella finestra temporale dai 6 ai 12 mesi precedenti lo screening e dopo la conferma della soppressione virologica a livelli <50 c/mL, qualsiasi misurazione dei livelli plasmatici di HIV-1 RNA >200 c/mL. -3.Nella finestra temporale dai 6 ai 12 mesi precedenti lo screening e dopo la conferma della soppressione virologica a livelli <50 c/mL, 2 o più misurazioni dei livelli plasmatici di HIV-1 RNA ¿>=50 c/mL.- 4.Una qualsiasi interruzione del trattamento nella finestra temporale compresa tra l’inizio della prima terapia antiretrovirale anti-HIV e i 6 mesi precedenti lo screening, esclusi i brevi periodi (inferiori a un mese) di interruzione di tutte le terapie antiretrovirali per problemi di tollerabilità e/o sicurezza. -5.Qualsiasi passaggio a un regime di seconda linea, definito come il cambiamento di uno o più farmaci contemporaneamente, dovuto a fallimento virologico (definito come una misurazione dei livelli plasmatici di HIV-1 RNA ¿400 c/mL dopo l’iniziale soppressione a <50 c/mL con il regime terapeutico anti-HIV di prima linea).
    Condizioni cliniche che determinano l’esclusione dallo studio
    7.Evidenze cliniche di patologia attiva di Categoria C secondo la classificazione Centers for Disease Control e Prevention (CDC). Tra le eccezioni vi sono il sarcoma di Kaposi cutaneo che non richieda terapia sistemica e un’anamnesi di conta dei linfociti CD4+ <200 cellule/mm3. -8.Soggetti con compromissione epatica severa (Classe C) in base alla classificazione di Child-Pugh. - 13.Presenza di tumore maligno diverso da sarcoma di Kaposi cutaneo, carcinoma basocellulare o carcinoma a cellule squamose non invasivo asportato o neoplasia intraepiteliale cervicale; in presenza di altri tumori maligni localizzati, per l’inclusione del soggetto è necessario un accordo tra lo sperimentatore e il medical monitor dello studio prima della randomizzazione.
    14.Soggetti che, a giudizio dello sperimentatore, presentano un rischio significativo di suicidio. Nella valutazione del rischio di suicidio si deve tenere in considerazione un’eventuale anamnesi di ideazione e/o comportamenti suicidari. - 18. Immunoterapia con vaccino anti-HIV-1 nei 90 giorni precedenti lo screening. 19.Trattamento con uno qualsiasi dei seguenti agenti nei 28 giorni precedenti lo screening: radioterapia, agenti chemioterapici citotossici, immunomodulatori che alterano la risposta immunitaria (per alcuni esempi si rimanda all’SPM).
    20.Esposizione a un farmaco o a un vaccino sperimentale nei 28 giorni oppure in un periodo pari a 5 emivite dell’agente sperimentale o a due volte la durata dell’effetto biologico del medesimo (si applica il periodo più lungo) precedente/i il giorno 1 del presente studio.
    Per gli ulteriori criteri di esclusione vedere protocollo pag. 34 sez. 5.2
    E.5 End points
    E.5.1Primary end point(s)
    Proportion of subjects with plasma HIV-1 RNA <50 copies per milliliter (c/mL) at Week 48 using the Snapshot algorithm for the Intent-to-treat exposed (ITT-E) population.
    • Percentuale di soggetti con livelli plasmatici di HIV-1 RNA <50 copie per millilitro (c/mL) alla settimana 48, calcolati tramite l’algoritmo Snapshot per la popolazione intent-to-treat esposta (ITT-E)
    E.5.1.1Timepoint(s) of evaluation of this end point
    48 weeks
    48 settimane
    E.5.2Secondary end point(s)
    Change from Baseline in CD4+ lymphocyte count at Weeks 24 and 48; Proportion of subjects with plasma HIV-1 RNA <50 c/mL at Week 24, using the Snapshot algorithm for the ITT-E Population; Incidence and severity of adverse events (AEs) and laboratory abnormalities over 48 weeks; Proportion of subjects who discontinue treatment due to AEs over 48 weeks; Change from Baseline in renal, bone, and cardiovascular biomarkers at Week 48; Change from Baseline in fasting lipids at Weeks 24 and 48; Incidence of observed genotypic and resistance to CAR and to DTG or RPV for subjects meeting Virologic Withdrawal Criteria; Pre-dose concentrations of DTG and RPV at Weeks 4, 24, 48, 56, 76, 100, or Withdrawal in subjects switching to DTG + RPV . Pre-dose concentrations of DTG and RPV at Weeks 2, 4 and 8 in the first 20 subjects who switch from EFV or NVP to DTG +RPV
    By Baseline third agent treatment class:
    Proportion of subjects with plasma HIV-1 RNA <50 c/mL at Week 48 using the Snapshot algorithm for the ITT-E Population; Changes from Baseline in CD4+ lymphocyte counts at Week 48; Incidence and severity of AEs and laboratory abnormalities over 48 weeks; Proportion of subjects who discontinue treatment due to AEs over 48 weeks; Incidence of observed genotypic and phenotypic resistance to current antiretroviral regimen and to DTG or RPV for subjects meeting Virologic Withdrawal Criteria; Change from Baseline in fasting lipids at Weeks 24 and 48; Between and within treatment group comparisons will be assessed on change from Baseline in pre-specified treatment symptoms (using the HIV Symptom Index) at Weeks 4, 24, 48, 56, 76, 100 and 148 (or Withdrawal from the study); Between and within treatment group comparisons will be assessed on change from Baseline treatment satisfaction (using the HIV TSQ) at Weeks 4, 24, 48, 56, 76, 100 and 148 (or Withdrawal from the study)
    ¿ Variazione rispetto al basale in termini di conta dei linfociti CD4+ alle settimane 24 e 48¿Percentuale di soggetti con livelli plasmatici di HIV-1 RNA <50 c/mL alla settimana 24, calcolati tramite l¿algoritmo Snapshot per la popolazione ITT-E¿Incidenza e gravit¿ degli eventi avversi (EA) e anomalie di laboratorio nel corso di 48 settimane¿Percentuale di soggetti che interrompono il trattamento per l¿insorgenza di EA nell¿arco di 48 settimane¿Variazione rispetto al basale dei biomarcatori renali, ossei e cardiovascolari alla settimana 48 ¿Variazione rispetto al basale dei lipidi a digiuno alle settimane 24 e 48¿Incidenza delle resistenze genotipiche e fenotipiche osservate al CAR e a DTG o RPV in soggetti che soddisfano i criteri di ritiro virologico¿Concentrazioni predose di DTG e RPV alle settimane 4, 24, 48, 56, 76, 100 o al ritiro dallo studio in soggetti che passano al trattamento con DTG + RPV¿Concentrazioni predose di DTG e RPV alle settimane 2, 4 e 8 nei primi 20 soggetti che passano da EFV o NVP a DTG + RPV
    ¿Per ogni classe del terzo agenti di trattamento al basale:-Percentuale di soggetti con livelli plasmatici di HIV-1 RNA <50 c/mL alla settimana 48 calcolati tramite l¿algoritmo Snapshot per la popolazione ITT-E-Variazioni rispetto al basale in termini di conta dei linfociti CD4+ alla settimana 48-Incidenza e gravit¿ degli EA e anomalie di laboratorio nel corso di 48 settimane-Percentuale di soggetti che interrompono il trattamento per l¿insorgenza di EA nell¿arco di 48 settimane-Incidenza delle resistenze genotipiche e fenotipiche osservate al CAR e a DTG o RPV in soggetti che soddisfano i criteri di ritiro virologico-Variazione rispetto al basale dei lipidi a digiuno alle settimane 24 e 48¿Saranno effettuati confronti tra gruppi ed entro gruppi riguardo alla variazione rispetto al basale di alcuni sintomi del trattamento prespecificati (tramite Symptom Distress Module) alle settimane 4, 24, 48, 56, 76, 100 e 148 (o al ritiro dallo studio)¿Saranno effettuati confronti tra gruppi ed entro gruppi riguardo alla variazione rispetto al basale della soddisfazione nei confronti del trattamento (tramite questionario HIV TSQ) alle settimane 4, 24, 48, 56, 76, 100 e 148 (o al ritiro dallo studio)
    E.5.2.1Timepoint(s) of evaluation of this end point
    48 weeks
    48 settimane
    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 No
    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 Yes
    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) No
    E.7.3Therapeutic confirmatory (Phase III) Yes
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group Yes
    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) Yes
    E.8.2.2Placebo No
    E.8.2.3Other Yes
    E.8.2.3.1Comparator description
    attuale regime antiretrovirale (CAR)
    current antiretroviral regimen (CAR)
    E.8.2.4Number of treatment arms in the trial2
    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 concerned5
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA43
    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 Information not present in EudraCT
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Australia
    Canada
    Russian Federation
    Taiwan
    United States
    Belgium
    France
    Germany
    Italy
    Netherlands
    Spain
    United Kingdom
    Argentina
    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
    The end of the study is defined as the last subject's last visit/Contact
    La definizione di conclusione della sperimentazione ¿ ultima visita/contatto dell'ultimo soggetto.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years6
    E.8.9.1In the Member State concerned months0
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years6
    E.8.9.2In all countries concerned by the trial months0
    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 No
    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) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 466
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 10
    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 Yes
    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 No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state25
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 229
    F.4.2.2In the whole clinical trial 476
    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)
    The investigator is responsible for ensuring that consideration has been given to the poststudy care of the subject's medical condition whether
    or not GSK is providing specific post-study treatment.
    Subjects who have successfully completed 148 weeks of treatment will be given the opportunity to continue to receive DTG + RPV until one of
    the following occurs:
    Please refer to the protocol (page 47, section 6.7) for the criteria.
    Lo sperimentatore ha la responsabilit¿ di assicurare che sia stata prestata la dovuta attenzione alla gestione della condizione clinica del soggetto dopo la conclusione dello studio, indipendentemente dal fatto che GSK fornisca o meno trattamenti specifici successivamente alla conclusione dello studio.
    Ai soggetti che avranno completato con successo le 148 settimane di trattamento sar¿ offerta l¿opportunit¿ di continuare a ricevere DTG + RPV fino al verificarsi di una delle seguenti condizioni:
    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 Decision2015-06-15
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2015-06-04
    P. End of Trial
    P.End of Trial StatusCompleted
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