HIV Infections Clinical Trial
Official title:
Switch From Etravirine to Doravirine as a Part of Antiretroviral Combination in Virologically Suppressed People Living With HIV (PLWH): the French Multicenter, Observational SWEED Study
The main objective of the SWEED study is to determine whether doravirine containing ART is able to maintain viral suppression at W48 in HIV-1 infected people living with HIV (PLWH) receiving etravirine containing ART: - An ARV strategy containing doravirine as a replacement for etravirine can maintain virological suppression in participants with controlled viral replication under ARV treatment containing etravirine, with a virological success rate >90% - This strategy can maintain virological suppression even in the event of NNRTI resistance mutations acquired in the past - This strategy is well tolerated - The emergence of resistance to NNRTIs is uncommon in the event of virological failure under the ARV regimen containing doravirine
The evolution of HIV infection from fatal to chronic has been enabled by advances in development and access of antiretroviral treatment (ART), which has also resulted in life expectancy of PLWH approaching that of those uninfected.In addition, over the past few years, new drugs and news regimens have offered improved efficacy, safety and tolerability. The 95-95-95 UNAIDS target, i.e. to diagnose 95% of PLWHIV (1st 95), provide ART to 95% of those diagnosed with HIV (2nd 95), and to reach viral suppression in 95% of patients on ART (3rd 95), is being achieved in several countries. Calls to add a fourth target, i.e. to improve the quality of life for PLWHIV, have grown stronger since the concept was introduced in 2016. The twin aims are long-term treatment durability and improved quality of life with a focus on personalized treatment. Switching or simplifying ART in the setting of HIV suppression may improve pill burden, dosing frequency, safety, tolerability, and/or food requirements. At times, ART switch or simplification is elective, such as consolidating a multiple-tablet to a single-tablet regimen (STR). Other times, it is necessary to eliminate drug-drug interactions (DDIs) and/or minimize active or potential treatment-associated adverse events (AEs). The fundamental principle of switching or simplifying ART is to preserve virologic suppression without jeopardizing future ART options. Etravirine, a second generation NNRTI, has been demonstrated to be effective on HIV strains with prior resistance mutations on reverse transcriptase impacting other NNRTIs, such as nevirapine, efavirenz or rilpivirine. It has even been used in salvage therapy, in association with darunavir and raltegravir, in uncontrolled patients with multiresistant strains. Etravirine is mostly prescribed twice daily, and is a strong enzymatic inducer providing many DDIs, complicating its use. Doravirine, a last generation NNRTI, is approved in treatment-naïve and experienced HIV-infected individuals. In the DRIVE-FORWARD study, doravirine 100 mg QD, in combination with either TDF/FTC or ABC/3TC, achieved high virologic success at week 48 and was non-inferior to DRV/r + 2 NRTIs regardless of baseline HIV-RNA. In the DRIVE-AHEAD study, in treatment-naïve adults with HIV-1 infection, doravirine + 3TC/TDF administered once daily demonstrated a high antiviral potency with non-inferior efficacy to EFV/FTC/TDF regardless of baseline HIV-RNA, and a low rate of resistance, with only 1.6% of participants developing resistance to any study drug through W48. For virologically suppressed patients considering a change in therapy, switching to DOR/3TC/TDF was shown to be a well-tolerated option which was non-inferior to continuation of the previous regimen, with high rates of virologic suppression and low rates of virologic rebound. Long term results from the DRIVE-SHIFT trial showed that doravirine maintained virologic suppression and was generally well tolerated through 144 weeks of treatment. DOR/3TC/TDF as switch therapy showed a favorable lipid profile compared with previous regimens and results in minimal weight gain. The convenience achieved through switching to a DOR based regimen serves to achieve regimen simplification and could respond to patient demands for increased tolerability. The DOR resistance profile is distinct from that of other NNRTIs with the in vitro selection of mutations at reverse transcriptase (RT) positions 106, 108, 188, 227, 230, 234 and 236. In vitro studies have also suggested that DOR has activity against viruses with certain mutations selected by other NNRTIs, including the K103N and Y181C mutations. In the DRIVE-SHIFT trial, conducted in virologically suppressed patients, 24 participants had a virus with baseline NNRTI mutations (K103N, Y181C and G190A) and 23/24 who switched to DOR/3TC/TDF remained virologically suppressed at the 48-week follow-up. This suggests that the most frequent NNRTI mutations at RT mutation positions 103, 181 and 190 probably not impact DOR activity in vivo. Due to its virological properties, we believe that doravirine can advantageously replace etravirine, maintaining control of viral replication, in combination with other antiretrovirals, in virologically controlled patients, despite possible exposure to NNRTIs in the pass. Furthermore, doravirine is taken as a single tablet once a day, and causes almost no drug interactions, unlike etravirine. ;
Status | Clinical Trial | Phase | |
---|---|---|---|
Completed |
NCT05454514 -
Automated Medication Platform With Video Observation and Facial Recognition to Improve Adherence to Antiretroviral Therapy in Patients With HIV/AIDS
|
N/A | |
Completed |
NCT03760458 -
The Pharmacokinetics, Safety, and Tolerability of Abacavir/Dolutegravir/Lamivudine Dispersible and Immediate Release Tablets in HIV-1-Infected Children Less Than 12 Years of Age
|
Phase 1/Phase 2 | |
Completed |
NCT03067285 -
A Phase IV, Open-label, Randomised, Pilot Clinical Trial Designed to Evaluate the Potential Neurotoxicity of Dolutegravir/Lamivudine/Abacavir in Neurosymptomatic HIV Patients and Its Reversibility After Switching to Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide. DREAM Study
|
Phase 4 | |
Completed |
NCT03141918 -
Effect of Supplementation of Bioactive Compounds on the Energy Metabolism of People Living With HIV / AIDS
|
N/A | |
Recruiting |
NCT04579146 -
Coronary Artery Disease (CAD) in Patients HIV-infected
|
||
Completed |
NCT06212531 -
Papuan Indigenous Model of Male Circumcision
|
N/A | |
Active, not recruiting |
NCT03256422 -
Antiretroviral Treatment Taken 4 Days Per Week Versus Continuous Therapy 7/7 Days Per Week in HIV-1 Infected Patients
|
Phase 3 | |
Completed |
NCT03256435 -
Retention in PrEP Care for African American MSM in Mississippi
|
N/A | |
Completed |
NCT00517803 -
Micronutrient Supplemented Probiotic Yogurt for HIV/AIDS and Other Immunodeficiencies
|
N/A | |
Active, not recruiting |
NCT03572335 -
Systems Biology of Diffusion Impairment in Human Immunodeficiency Virus (HIV)
|
||
Completed |
NCT04165200 -
Fecal Microbiota Transplantation as a Therapeutic Strategy for Patients Infected With HIV
|
N/A | |
Recruiting |
NCT03854630 -
Hepatitis B Virus Vaccination in HIV-positive Patients and Individuals at High Risk for HIV Infection
|
Phase 4 | |
Terminated |
NCT03275571 -
HIV, Computerized Depression Therapy & Cognition
|
N/A | |
Completed |
NCT02234882 -
Study on Pharmacokinetics
|
Phase 1 | |
Completed |
NCT01618305 -
Evaluating the Response to Two Antiretroviral Medication Regimens in HIV-Infected Pregnant Women, Who Begin Antiretroviral Therapy Between 20 and 36 Weeks of Pregnancy, for the Prevention of Mother-to-Child Transmission
|
Phase 4 | |
Recruiting |
NCT05043129 -
Safety and Immune Response of COVID-19 Vaccination in Patients With HIV Infection
|
||
Not yet recruiting |
NCT06072443 -
AURORA Study-A Transformative Approach to Support PrEP Medication Persistence
|
||
Not yet recruiting |
NCT05536466 -
The Influence of Having Bariatric Surgery on the Pharmacokinetics, Safety and Efficacy of the Novel Non-nucleoside Reverse Transcriptase Inhibitor Doravirine
|
N/A | |
Recruiting |
NCT04985760 -
Evaluation of Trimer 4571 Therapeutic Vaccination in Adults Living With HIV on Suppressive Antiretroviral Therapy
|
Phase 1 | |
Completed |
NCT05916989 -
Stimulant Use and Methylation in HIV
|