Romidepsin Plus 3BNC117 Phase 2a Study

Human Immunodeficiency Virus (HIV) Clinical Trial

— ROADMAP  

Official title:

A Phase 2a, Randomized Study of Romidepsin With or Without 3BNC117 to Evaluate the Effects on the HIV-1 Reservoir (ROADMAP)

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT02850016
• Other study ID #: MCA-0896
• Status: Completed
• Phase: Phase 2
• Start date: January 6, 2017
• Est. completion date: December 31, 2020

Study information

• Verified date: July 2022
• Source: Rockefeller University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The aim of this protocol is to evaluate the effects of romidepsin plus 3BNC117 or romidepsin alone on delaying or preventing viral rebound in ART-treated HIV-1-infected individuals during an analytical interruption of ART.

Description:

This is a randomized interventional phase 2a trial of 3BNC117 and romidepsin in human immunodeficiency (HIV-1) infected patients on ART, conducted as a multi-center study at the Department of Infectious Diseases, Aarhus University Hospital, Denmark, the Rockefeller University Hospital, USA, and the University Hospital of Cologne, Germany. Participants will be randomized 1:1 in a non-blinded fashion to receive one of two regimens: A) Two treatment cycles each consisting of one 3BNC117 infusion (30mg/kg) + three romidepsin infusions (5mg/m2); or B) Two treatment cycles each consisting of three romidepsin infusions (5mg/m2). ART will be discontinued 16 weeks after the start of the second treatment cycle (analytical treatment interruption, ATI) and subjects will be monitored weekly for safety and viral rebound. The targeted enrollment is 30 subjects (15 per arm). Leukapheresis will be performed before and after the two treatment cycles to guarantee sufficient material to investigate changes in the reservoir after the interventions. The following criteria will require resumption of ART: - CD4+ T cell-count <350 cells/mm³ (confirmed by repeat measurement) - 2 consecutive plasma HIV-1 RNA measurements ≥ 200 copies/mL or above their setpoint viremia (if documented) - Subject request - Continued ART interruption will, in the opinion of the investigator or study advisers, pose an unacceptable risk to the subject. If HIV-1 RNA remains undetectable at week 36, subjects will be offered to continue off ART with close monitoring, in conjunction with the subject's primary medical provider, as long as HIV-1 viral rebound does not occur. ART resumption will follow same criteria as detailed above. All subjects will be followed for a total of 48 weeks from enrollment.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 48
• Est. completion date: December 31, 2020
• Est. primary completion date: December 31, 2020
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 65 Years

Eligibility

Inclusion Criteria:

• Adults age 18-65 years with documented HIV-1 infection
• CD4+ T-cell count >500 cells/mm3 at screening
• On ART for a minimum of 24 months and HIV-1 RNA plasma level of < 50 copies/ml by standard assays for at least 18 months (a single viral load measurement > 50 but < 500 copies/ml during this time period is allowable).
• Individuals on protease inhibitor or NNRTI-based regimens, or regimens containing cobicistat must be willing to switch to an integrase-inhibitor-based regimen (raltegravir or dolutegravir) prior to enrollment.

Exclusion Criteria:

• Use of systemic corticosteroids, immunosuppressive anti-cancer, or other medications considered significant by the investigators within the last 6 months
• Pregnancy as determined by a positive urine or serum beta-hCG.
• Participant unwilling to use two reliable contraception methods (i.e. condom with spermicide, diaphragm with spermicide, progestin-only containing intrauterine device (IUD) (eg, Mirena, Implanon, Nuva Ring), non-estrogen containing formulations of hormonal birth control drugs with condom) for the study duration.
• Currently breast-feeding.
• History of resistance to 2 or more classes of antiretroviral medications
• Any medical, psychiatric, social, or occupational condition that, as judged by the investigators, would interfere with the evaluation of study objectives (such as severe alcohol or drug abuse, dementia).
• Acute or chronic hepatitis B or C infection as indicated by the presence of Hepatitis B surface antigen (HBsAg) or hepatitis C virus RNA (HCV-RNA) in blood.
• A history of AIDS-defining illness within 3 years prior to enrollment.
• History of B-cell lymphoma, including CNS lymphoma
• CD4 nadir < 200 cells/mm3
• History of significant coronary artery disease, myocardial infarction, percutaneous coronary intervention with placement of cardiac stents, or family history of sudden death at age < 50 years.
• ECG at screening that shows QTc >450 msec when calculated using the Fridericia formula from either lead V3 or V4, pathological Q-waves (Q-wave > 40 msec or depth > 0.4-0.5 mV), evidence of a ventricular pre-excitation syndromes, complete or incomplete LBBB or RBBB, second or third degree heart block, QRS duration > 120 msec, or bradycardia defined by sinus rate < 50 bps
• Use of QT-prolonging medication, renal or hepatic disease, structural heart disease or left ventricular dysfunction
• Any symptomatic or asymptomatic arrhythmia excluding sinus arrhythmia and bradycardia = 50 bps.
• Laboratory abnormalities in the parameters listed below:

1. Absolute neutrophil count = 1,000 cells/µl

2. Hemoglobin < 11 gm/dL

3. Platelet count < 125,000 cells/µl

4. Alanine Aminotransferase (ALT) = 1.25 x ULN

5. Aspartate Aminotransferase (AST) = 1.25 x ULN

6. Total bilirubin > 1.0 ULN

7. Creatinine > 1.0 ULN

• Any vaccination within 14 days prior to 3BNC117 administration
• Receipt of any therapeutic HIV vaccine in the past
• Receipt of any monoclonal antibody or HDAC inhibitor of any kind in the past.
• Participation in another clinical study of an investigational product currently or within past 12 weeks, or expected participation during this study.

Related Conditions & MeSH terms

• Acquired Immunodeficiency Syndrome
• HIV Infections
• Human Immunodeficiency Virus (HIV)

Intervention

Drug:
• 3BNC117
Intravenous Infusion of 3BNC117
• Romidepsin
Intravenous Infusion of Romidepsin

Locations

Country	Name	City	State
Denmark	Aarhus University Hospital	Aarhus
Germany	University of Cologne	Cologne
United States	The Rockefeller University	New York	New York

Sponsors (3)

Lead Sponsor	Collaborator
Rockefeller University	Aarhus University Hospital, University Hospital of Cologne

Countries where clinical trial is conducted

United States,  Denmark,  Germany, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	HIV-1 Transcriptional Activity as Determined by Unspliced HIV-1 RNA (CA usHIV-1 RNA) in Circulating Total CD4+ T Cells.	The median fold-change in cell-associated unspliced HIV-1 RNA concentrations after romidepsin administration across all infusions	baseline and week 24
Primary	Days to Viral Rebound During Analytical Treatment Interruption (ATI)	Viral rebound is defined as HIV-1 RNA = 200 copies/mL on 2 consecutive measurements during ATI. If viral rebound occurs, the date of the first measurement of HIV-1 RNA = 200 copies/mL will be defined as "date of viral rebound	Week 24 to Week 36
Secondary	Number of of Adverse Events (AE), Serious Adverse Events (SAE), and Serious Unexpected Serious Adverse Reactions (SUSAR).	The occurrence of adverse events was assessed during each follow up visit. Adverse events of grades 1 or higher were reported.	48 weeks
Secondary	Change in the Size of the Proviral HIV-1 Reservoir	Determined by total HIV-1 DNA and episomal HIV-1 DNA (2-LTR) in circulating total CD4+ T cells at baseline and prior to the ATI period (week 24).	baseline and week 24
Secondary	Plasma HIV-1 RNA	As measured by a routine clinical assay (Cobas Taqman; detection limit 20 copies/mL), a transcription mediated amplification (TMA)-based assay (detection limit 12 copies/ml) and/or a single copy assay (detection limit 1-2 copies/mL)	48 weeks